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
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
SWORN T0 AND SUBSCRIBED before me on ________________________, _______
Month Day Year
State of ___________________________________
County of _________________________________