1. On or about the ____________ day of ____________________, 20_____________, the defendant unlawfully arrested and imprisoned the plaintiff (or caused the plaintiff to be arrested and imprisoned as the case may be) on a charge of larceny (or as the case may be) for __________________ days.
Wherefore plaintiff demands judgment against defendant in the sum of ________________ dollars and costs.
Miss. R. Civ. P. Form 17