STATE OF INDIANA     )
                              )
SS: IN THE DELAWARE COUNTY COURT SYSTEM
TERM
Your Name
Plaintiff
vs.
Person You Filed Against
Judgment Defendant
Employer
Garnishee Defendant
CAUSE NO. Court Cause Number
MOTION FOR PROCEEDINGS SUPPLEMENTAL

The plaintiff petitions the Court and says:

WHEREFORE, plaintiff prays as follows:

I AFFIRM UNDER THE PENALTIES FOR PERJURY THAT THE FOREGOING REPRESENTATIONS ARE TRUE.