Plaintiff:
Name
Plaintiff's contact information:
Name
Street Address
City State ZIP Code
Email Address
Phone Number
Bar Number
Defendant:
Name
Civil Action File No.
Street Address
City State ZIP Code
Garnishee:
Name
Street Address
City State ZIP Code
Ne ee A a a Sa a a
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 —_——— — — in the Court of
County, , and no agreement State
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.
5. The Affiant believes that the Garnishee is an employer of or under periodic obligations for payment of funds to the Defendant.
This day of , 20 Affiant Print name of Affiant Sworn to and subscribed before me this ___—_— day of , 20
Notary Public or Deputy Clerk of Court”