STATE OF INDIANA )
) SS:
COUNTY OF DELAWARE )
IN THE DELAWARE COUNTY COURT SYSTEM
  TERM
Your Name
Plaintiff
vs.
Person You Filed Against
Defendant
CAUSE NO. 18 Case Number
AFFIDAVIT OF NON-MILITARY SERVICE,
COMPETENCY, AND PROOF OF CLAIM
Your name, being first duly sworn upon his/her oath, deposes and says:
1.
That the defendant(s) in the above-entitled cause of action is/are not member(s) of the Armed Forces of the United States of America; is/are at least eighteen (18) years of age and not otherwise incompetent.
2.
That Person You Filed Against (defendant) was/were and is/are justly and truly indebted to the plaintiff in the sum of $Judgment Amount and the consideration for the debt is as follows: note; promise; goods; contract; lease; loan; other:  .
3.
That said sum is now due and wholly unpaid; that there are no set-offs or counter-claims to the claim; that the plaintiff has not received or accepted and does not now hold any collateral or other security for the debt whatsoever.
DATED: Date
Your Signature
(Signature)