IN THE COUNTY COURT, EIGHTH JUDICIAL CIRCUIT IN AND FOR ALACHUA COUNTY, FLORIDA , CASE NO.:Ol- Plaintiff, Address City, State,Zip Phone -vs- Defendant(s) Address City, State,Zip Phone PROOF OF CLAIM AFFIDA VIT I, theundersigned,beingfirstdulyswornaccordingto law,doherebydeclareandaffirm: 1. ThatI am (a)- thePlaintiffor (b)- anemployeeor agentof thePlaintiff; 2. ThatI havepersonalknowledgeof the factsstatedbelow; 3. Thattherearesumsdueandowingto thePlaintiffITomtheDefendantas follows: PRINCIPAL $ INTEREST $ COURT COSTS $, ATTORNEYS FEES $, ADDITIONAL COSTS $. TOTAL $ Plaintiff/Plaintiffs employeeor agentSWORN TO AND SUBSCRffiED BEFORE ME THIS - dayof ,20 NotaryPublicor DeputyClerk