STATE OF INDIANA )
)SS:
COUNTY OF DELAWARE )
IN THE DELAWARE CIRCUIT COURT NO.
Plaintiff/Petitioner
CAUSE NO.
vs.
Defendant/Respondent

AFFIDAVIT FOR CITATION

Comes now the plaintiff in the above-captioned case, under penalties for perjury, states as follows:

I SWEAR OR AFFIRM UNDER THE PENALTY OF PERJURY THAT THE FOREGOING REPRESENTATIONS ARE TRUE AND CORRECT.

DATED:
Signature of Plaintiff/Petitioner
Address (Street)
(City, State, Zip)
Phone Number