IN THE COUNTY COURT OF THE SECOND JUDICIAL CIRCUIT, IN AND FOR LEON COUNTY, FLORIDA CASE NO. _____ __________________________ Plaintiff(s), vs. _______________________________ Defendant(s). AFFIDAVIT OF NON-COMPLIANCE WITH STIPULATION/AGREEMENT STATE OF ____________ COUNTY OF __________ BEFORE ME, the undersigned authority, personally appeared, ________________________________________________________, to me well known, who has personal knowledge after being duly sworn, deposes and says that: 1. I am the records custodian for the Plaintiff(s) and I am in full charge and familiar with the books and accounts of Plaintiff(s). I have ascertained that the above-named Defendant(s) is/are justly and duly indebted to the said Plaintiff(s) at the time of filing the lawsuit for the sum of $_____________________, plus prejudgment interest in the sum of $______________________, for a total sum sued upon of $________________________. 2. Affiant further states that Defendant(s) have failed to comply with said Stipulation. 3. Further Affiant states that the sum of $_________________ is still due and owing. 4. Revised 11/6/2006 The Plaintiff moves this Court for entry of a Final Judgment against Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com Defendant(s), _______________________________________________________ without further notice. ________________________________ AFFIANT STATE OF ______________ COUNTY OF____________ The foregoing instrument was acknowledged before me this ________ day of _______________________, ______, by _____________________________, who is personally knowned to me or who has produced _____________________ as identification and who did [ ] did not [ ] take an oath. ________________________________ Notary Public, State of Florida ________________________________ (Printed Name) Revised 11/6/2006 Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com