Letter of Affidavit of Creditors : Please fill out the following form. Please print your completed form if you would like to have a copy for your records.
I (Name of the person giving statement) of (Address of the person giving statement) the undersigned, being of age, do of my own personal knowledge make the following statements and declare them to be true.
1. That I am (Name of the person giving statement) of (Address of the person giving statement) Plaintiff in this action and have custody of its book and records.
2. That according to said books and records, and my own personal knowledge, Defendant is justly indebted to Plaintiff in the amount of $ without setoff or defense.
3. That despite repeated demand for payment, no payment has been received.
4. That there is no insurance coverage or other posted security from which to satisfy this claim.
Signed under the pains and penalties of perjury this day of :
STATE OF :
COUNTY OF :
On _______________________ before me _________________________ personally appeared ___________________________ personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
WITNESS my hand and official seal.
Affiant : Known / Unknown :
ID Produced :
Letters for Credit and Collection Index
Letter of Affidavit of Creditors
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