Affidavit (Balance Due On Stipulation) (Pinellas)
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Affidavit (Balance Due On Stipulation) (Pinellas) Form. This is a Florida form and can be use in Pinellas Local County.
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Tags: Affidavit (Balance Due On Stipulation) (Pinellas), Florida Local County, Pinellas
COUNTY COURT, PINELLAS COUNTY, FLORIDA SMALL CLAIMS DIVISION UCN: ______________________________Reference No.: ______________________________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
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_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Plaintiff(s) VS. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
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_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Defendant(s) AFFIDAVIT (Balance Due on Stipulation) STATE OF FLORIDA : COUNTYOF PINELLAS : ss. Before me, the undersigned personally appeared _________________________
____________________ , who, by me first duly sworn, states: 1. That he/she is the Plaintiff(s) who entered into the written stipulation filed in this cause. 2. That the Defendant(s) ________________________________________________
________has failed to make payment(s) pursuant to that agreement. 3. The last payment was made on _________________________________________________ , _
________ . 4. The balance left due and owing under the agreement is $ ____________________________ pr
incipal and $ _______________________________ costs. WHEREFORE, Plaintiff (s) request the court to enter a Judgment for $ ____________________
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_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Plaintiff(s) SWORN TO AND SUBSCRIBED before me at ____________________________________________
__________ , this ___________________ day of ________________________________ , _____
____ . ________________________________________________ Deputy Clerk or Notary Public State of Florida My commission expires: SC 034 (Rev. 1/1/03) SC034 12/02 American LegalNet, Inc. www.USCourtForms.com
