EXHIBIT "____"

BUSINESS RECORDS AFFIDAVIT

THE STATE OF ________________________

COUNTY OF __________________________

Before me, the undersigned authority, on this day personally appeared the undersigned affiant who, being by me duly sworn, on oath stated:

1) My name is _________________________________________, I am at least eighteen years of age, of sound mind, capable of making this affidavit, and fully competent to testify to the matters stated herein, and l have personal knowledge of each of these matters stated.

2) I am presently employed by ________________________________________, Plaintiff

in the capacity of ________________________________________________, and I have been

so employed since ___________.  As part of my duties in that employment I am custodian of the business records of Plaintiff which includes the records applicable to ___________________, Defendant in this cause of action.

3) Attached to Plaintiff's Original Petition as Exhibit "A" is a copy of the current note and/or a copy of the statement of Services and/or Goods provided and/or a Notarized Statement as to the terms and agreements of contract and/or Proof of Receipt of Services and/or Goods provided to the above mentioned Defendant.

4) Each record was kept by Plaintiff in the regular course of business. It was the regular course of Plaintiff's business for the Plaintiff or an employee or representative of Plaintiff with personal knowledge of the act, event, or condition recorded, to make the record or to transmit information to be included in that record.

5) Each record attached to this affidavit was made at or near the time of the act, event, or condition recorded or reasonably soon thereafter and each copy attached is an exact duplicate of the original record, and each copy was made under my personal supervisor.

6) After all just and lawful offsets, payments and credits, there remains owing by Defendant to

Plaintiff the principal balance of $___________ plus interest at the rate of ____% per annum.

7 On __________________ Plaintiff demanded that Defendant pay the monies owed to Plaintiff. Defendant has not paid the monies owed to Plaintiff

_________________________________________ ______________________
                         Affiant                                                                  Date

SWORN T0 AND SUBSCRIBED before me on ________________________, _______                                                                                                  Month Day Year  

_________________________________________
Notary Public

State of ___________________________________

County of _________________________________

Commission expires:_________________________