STATE OF ____________________________ )
COUNTY OF __________________________ )
BEFORE ME, the undersigned authority, on this day personally appeared the
undersigned affiant, who swore on oath that the following facts are true:
"1)My full name is _______________________________________.
"2) I am employed by ______________________________________________, the
Plaintiff named in the petition to which this affidavit is attached and made
a part hereof, and I have care, custody, and control of all records concerning
the account of the Defendant in this cause.
"3) These records show that a balance of $______________, is due and payable
by the Defendant
to _____________________________, Plaintiff.
"4) Defendant's account, marked as ('Exhibit A" and attached to Plaintiff's
Original Petition, is within my personal knowledge just and true. The true
amount of the account is due Plaintiff by Defendant, and all just and lawful
onsets, payrnents, and credits have been allowed.
"5) Demand for payment of the just amount owing Plaintiff by Defendant has
been made on Defendant more than thirty (30) days prior hereto and payment
for the just amount owing has not been tendered.''
SWORN T0 AND SUBSCRIBED before me on ________________________, _______
Month Day Year