Affidavit of Debt

STATE OF
COUNTY OF

I, , being duly sworn, depose and state as follows:

  1. I am (name and title), and I am authorized to make this affidavit on behalf of (creditor/plaintiff).
  2. The debtor, , owes a debt to the creditor/plaintiff in the amount of $ .
  3. The origin of the debt is as follows:
  4. The current amount owed is: $
  5. The undersigned affirms that the information provided is true and correct to the best of their knowledge.
Date:
Signature
Print Name
Subscribed and sworn to before me on this
day of
, 20
.
Notary Public
My Commission Expires: