Dram Shop Liability Complaint - Indiana

Indiana Personal Injury Updated October 29, 2026 Free Word and PDF

TABLE OF CONTENTS

  1. Caption
  2. Parties
  3. Jurisdiction and Venue
  4. Factual Allegations
  5. Count I - Negligence Per Se
  6. Count II - Common Law Negligence
  7. Damages
  8. Jury Demand
  9. Prayer for Relief
  10. Verification
  11. State-Specific Notes
  12. Sources and References

CAPTION

IN THE [________________________________] SUPERIOR COURT OF [________________________________] COUNTY
STATE OF INDIANA

Party Role
[PLAINTIFF], Plaintiff
v.
[DEFENDANT] (d/b/a [BUSINESS NAME]), Defendant

Cause No.: [________________________________]


PARTIES

  1. Plaintiff [________________________________] is a resident of [________________________________] County, Indiana, and is the person injured as a result of the acts described herein.

  2. Defendant [________________________________] (hereinafter "Provider Defendant") is a person or entity that furnished alcoholic beverages to the Intoxicated Person, operating as [________________________________], located at [________________________________], Indiana.

  3. [________________________________] (hereinafter "Intoxicated Person") was at all relevant times a patron who was furnished alcoholic beverages by the Provider Defendant.


JURISDICTION AND VENUE

  1. This Court has jurisdiction over this action pursuant to Ind. Code § 33-29-1-1.5.

  2. Preferred venue lies in this County under Ind. Trial Rule 75(A)([3 or 4]) because [the motor-vehicle accident occurred here / the Defendant's principal office or relevant office or agency is located here]: [________________________________].


FACTUAL ALLEGATIONS

  1. On or about [__/__/____], the Intoxicated Person was present at the Provider Defendant's establishment at [________________________________].

  2. The Provider Defendant, through its agents, employees, or servants, furnished alcoholic beverages to the Intoxicated Person.

  3. At the time of service, the Intoxicated Person was visibly intoxicated, as evidenced by:

☐ Slurred speech
☐ Unsteady gait or impaired balance
☐ Glassy, bloodshot, or unfocused eyes
☐ Aggressive, belligerent, or erratic behavior
☐ Impaired motor coordination
☐ Strong odor of alcohol
☐ Difficulty with basic tasks (e.g., handling money, opening doors)
☐ Other: [________________________________]

  1. The Provider Defendant had actual knowledge that the Intoxicated Person was visibly intoxicated at the time of furnishing. Facts supporting that allegation include:

☐ Staff observed and commented on the Intoxicated Person's condition
☐ Other patrons alerted staff to the Intoxicated Person's condition
☐ The server acknowledged the Intoxicated Person's visible intoxication
☐ Other: [________________________________]

  1. Despite this actual knowledge, the Provider Defendant continued to furnish alcoholic beverages.

  2. Following service, the Intoxicated Person [________________________________] [describe injurious conduct].

  3. The intoxication of the Intoxicated Person was a proximate cause of Plaintiff's injuries.

  4. Plaintiff suffered injuries including but not limited to [________________________________].


COUNT I - NEGLIGENCE PER SE (IND. CODE §§ 7.1-5-10-15(a), 7.1-5-10-15.5)

  1. Plaintiff re-alleges and incorporates paragraphs 1 through 13.

  2. Ind. Code § 7.1-5-10-15(a) prohibits a person who knows another person is intoxicated from selling, bartering, delivering, or giving away an alcoholic beverage to that person. Ind. Code § 7.1-5-10-15.5 limits civil liability to cases meeting its actual-knowledge and proximate-cause requirements.

  3. The Provider Defendant furnished alcoholic beverages to the Intoxicated Person.

  4. The Provider Defendant knew the Intoxicated Person was intoxicated and had actual knowledge of that person's visible intoxication at the time of furnishing, yet [sold / delivered / gave away] an alcoholic beverage to that person in violation of § 7.1-5-10-15(a).

  5. The intoxication of the Intoxicated Person was a proximate cause of the death, injury, or damage sustained by Plaintiff.

  6. The statutory violation and resulting intoxication proximately caused Plaintiff's injuries and damages.


COUNT II - COMMON LAW NEGLIGENCE

  1. Plaintiff re-alleges and incorporates paragraphs 1 through 13.

  2. The Provider Defendant owed a duty of care to Plaintiff to refrain from furnishing alcoholic beverages to visibly intoxicated persons.

  3. The Provider Defendant breached this duty by furnishing alcohol to the Intoxicated Person despite the person's visible intoxication and the Provider Defendant's actual knowledge thereof.

  4. The Provider Defendant's breach and the Intoxicated Person's intoxication were proximate causes of Plaintiff's injuries.

  5. As a result, Plaintiff has suffered damages as set forth herein.


DAMAGES

  1. As a direct and proximate result of the Defendant's conduct, Plaintiff has suffered:

☐ Past and future medical expenses
☐ Past and future lost wages and earning capacity
☐ Pain and suffering
☐ Mental anguish and emotional distress
☐ Loss of enjoyment of life
☐ Property damage
☐ Other: [________________________________]


JURY DEMAND

  1. Plaintiff hereby demands a trial by jury on all issues so triable.

PRAYER FOR RELIEF

WHEREFORE, Plaintiff respectfully requests that this Court:

a. Enter judgment against Defendant(s) and in favor of Plaintiff;
b. Award compensatory damages in an amount to be determined at trial;
c. Award interest to the extent permitted by law;
d. Award costs of this action;
e. Grant such other and further relief as this Court deems just and proper.


VERIFICATION

STATE OF INDIANA
COUNTY OF [________________________________]

I, [________________________________], being duly sworn upon my oath, state that I have read the foregoing Complaint and that the facts stated therein are true and correct to the best of my knowledge, information, and belief.

_____________________________________________
[________________________________], Plaintiff

State of Indiana, County of [________________________________].

Sworn to and subscribed before me this [____] day of [________________________________], [____].

_____________________________________________
Notary Public
Printed Name: [________________________________]
Commission Number: [________________________________]
My Commission Expires: [__/__/____]
Indiana county of notary commission (nonresident notary: Indiana county of primary employment): [________________________________]
Official Seal: [AFFIX NOTARY SEAL]


Respectfully submitted,

_____________________________________________
[________________________________]
Attorney for Plaintiff
[________________________________]
[________________________________]
Indiana Attorney No.: [________________________________]
Telephone: [________________________________]
Email: [________________________________]


STATE-SPECIFIC NOTES

  • Statute: Ind. Code § 7.1-5-10-15.5.
  • Actual Knowledge Standard: A furnisher must have had actual knowledge of visible intoxication at the time of furnishing; the person's intoxication must also have been a proximate cause of the alleged injury.
  • "Furnish" Defined: Section 7.1-5-10-15.5(a) includes bartering, delivering, selling, exchanging, providing, or giving away an alcoholic beverage.
  • Common Law: WEOC, Inc. v. Niebauer held that the Dram Shop Act modifies common-law negligence and negligence-per-se claims; it does not itself create an independent statutory cause of action.
  • Statute of Limitations: Two years (Ind. Code § 34-11-2-4).

SOURCES AND REFERENCES

  • Ind. Code § 7.1-5-10-15.5 (Indiana Dram Shop Act)
  • Ind. Code § 7.1-5-10-15(a) (sale to intoxicated person)
  • Ind. Code § 34-11-2-4 (Statute of Limitations)
  • Ind. Code § 33-29-1-1.5 (standard superior court jurisdiction)
  • Ind. Trial Rule 75(A) (preferred venue)
  • WEOC, Inc. v. Niebauer, No. 23S-CT-184 (Ind. Feb. 12, 2024)

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About this template

Last updated
October 29, 2026
Jurisdiction
Indiana
Category
Personal Injury

Legal authority

  • Ind. Code § 33-42-9-12(a)(5) (notary certificate county)
  • Ind. Code § 7.1-5-10-15.5 (Indiana Dram Shop Act)
  • Ind. Code § 7.1-5-10-15(a) (sale to intoxicated person)
  • Ind. Code § 34-11-2-4 (Two-Year Statute of Limitations)

Personal injury cases are brought by people who were hurt because of someone else's carelessness: car crashes, slip and falls, defective products, and more. Demand letters, settlement agreements, and court filings in these cases have to document the injuries, the medical treatment, the lost income, and the exact legal basis for holding the other side responsible. Well-prepared paperwork is what drives higher settlements and forces insurers to take the claim seriously.

Not legal advice

This template is provided for informational purposes. We recommend having an attorney review any legal document before signing, especially for high-value or complex matters.

Checked against the law it cites

The statutes this template relies on are listed under Legal authority.

Ind. Code § 33-42-9-12(a)(5)(B)(i) (checked October 29, 2026): "The Indiana county of the notary public's commission."

Ind. Code § 33-42-9-12(a), (b) (checked October 24, 2026): "A notary public who performs a notarial act on a tangible record shall: (1) affix, display, or emboss the notary public's official seal"

Ind. Code § 33-42-10-2(a)(4) (checked October 24, 2026): "The words "commission number" followed by the commission number of the notary public."

Ind. Trial Rule 8(A)(2) (checked October 21, 2026): "in any complaint seeking damages for personal injury or death, or seeking punitive damages, no dollar amount or figure shall be included in the demand."

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