AFFIDAVIT OF DEBT RE: MOTION FOR DEFAULT FOR FAILURE TO APPEAR, JUDGMENT AND ORDER FOR JD-CV-52 Rev. 5-99 P.B. §17-25 COURT USE ONLY STATE OF CONNECTICUT SUPERIOR COURT * A AH H * INSTRUCTIONS 1. Complete this affidavit and send original with your completed Motion for Default to Appear, Judgment and Order for Weekly Payments (JD-CV-49) and Notice of Judgment and Order of Payments (JD-CV-50) to the Clerk's Office. 2. Attach a copy of the contract, lease or other document, if applicable, to the completed affidavit. 3. If interest is being claimed, the period covered and the rate claimed must be stated. 4. If claiming attorney's fees, a copy of the agreement must be attached. 5. Send one copy of the completed Affidavit and Motion to each defendant. RETURN DATE DOCKET NO. TO: The Superior Court COURT HOUSING JUDICIAL SESSION DISTRICT NAME OF CASE (Plaintiff v. Defendant) G.A. NO. ADDRESS OF COURT (No., street, town, and zip code) NAME(S) OF (ALL) DEFENDANT(S) AGAINST WHOM MOTION IS FILED AFFIDAVIT OF DEBT (title) The undersigned deposes and says that (s)he is the Plaintiff or Plaintiff and is familiar with the facts stated below. The Defendant(s) is/are indebted to the Plaintiff(s) as follows: of the Continuation of this affidavit of debt is attached and made a part hereof. SIGNED (Affiant) PRINT NAME OF AFFIANT Subscribed and sworn to before me: SIGNED (Comm. of Sup. Court/Notary) DATE SIGNED 2000 (C) American LegalNet, Inc.