Plaintiff:
Name
Plaintiffs contact information:
Name
Civil Action File No. Street Address City State ZIP Code
E-mail Address
Phone Number
Bar Number vV.
Defendant:
Name
Street Address
City State ZIP Code
Garnishee:
Name
Street Address
City State ZIP Code
[C] Check this box if the Garnishee is a financial institution.
C] Check this box if garnishment is for the collection of child support or alimony. See O.C.G.A. § 18-4-50, et seq.
Personally appeared , who on oath says:
(Print name)
1. I am the (Plaintiff) (Attorney at Law for Plaintiff) (Agent for Plaintiff). [Circle one]
2. The Plaintiff obtained a judgment against the Defendant in
Case Number_ inthe
Court of County, , and State
no agreement requires forbearance from the garnishment which is
applied for currently.
3.$—— is the balance due, which consists of the sum of $—_—_—— Principal, $—— Postjudgment interest, and $_—_——— Other (e.g., prejudgment interest,
attorney’s fees, costs [exclusive of the cost of this action]).
4. Upon the Affiant’s personal knowledge or belief, the sum stated herein is unpaid.
This day of , 20 Affiant Print name of Affiant ai to and subscribed o me this day o ,
Notary Public or Deputy Clerk of Court”