Affidavit of Debt
Comes now affiant, and states:
I
(Name of Affiant)
am
Plaintiff
OR
a designated full-time employee of
(Name of Plaintiff)
(Plaintiff).
I am of adult age and am fully authorized by Plaintiff to make the following representations. I am familiar with
the record keeping practices of Plaintiff. The following representations are true according to documents kept in
the normal course of Plaintiff’s business and/or my personal knowledge:
Plaintiff:
is the original owner of this debt.
OR
has obtained this debt from
and the original owner of this debt was
.
(Name of Defendant)
, Defendant, has unpaid balance of
$
on account
(last 4 digits of acct. number or id only)
.
That amount is due and owing to Plaintiff. This account was opened on
.
The last payment from Defendant was received on
in the amount of
$.
The type of account is:
Credit card account (i.e. Visa, MasterCard, Department Store, etc.)
List the name of the Company/Store issuing credit card:
Account for utilities (i.e. telephone, electric, sewer, etc.)
Medical bill account (i.e. doctor, dentist, hospital, etc.)
Account for services (i.e. attorney fees, mechanic fees, etc.)
Judgment issued by a court (a copy of the judgment is required to be attached)
Other: (Please explain)
This account balance includes:
Late fees in the amount of
$
as of
(Month, Day, Year)
.
Other (Explain)
Interest at a rate of
%
beginning on
(Month, Day, Year)
.
Plaintiff:
is seeking attorney’s fees and additional evidence will be presented to the court prior to entry of judgment
on attorney’s fees.
OR
is not seeking attorney’s fees.