IN THE COUNTY COURT OF POLK COUNTY, FLORIDA CIVIL DIVISION CASE NO. ____________________________ Plaintiff, vs. Defendant. _________________________________________________/ AFFIDAVIT STATE OF FLORIDA COUNTY OF POLK the undersigned authority, personally appeared BEFORE ME, ________________________________________, the above named plaintiff, who, after being duly sworn, deposes and says: 1. On __________________________________, the plaintiff was awarded a judgment against the defendant in execution, _____________________________________________________________________________, in the sum of $____________ plus court costs of $____________ and interest; and 2. A Writ of Execution has been placed in the hands of the Sheriff of ________________ County, the county in which the defendant in execution resides and the Writ of Execution is valid and outstanding and remains unsatisfied; and 3. In accordance with the provisions of Florida Statute 56.29, the plaintiff requests proceedings supplementary to execution. _________________________________________ Plaintiff SWORN TO and subscribed before me this _____ day of _____________________, 20____. RICHARD M. WEISS, CLERK Circuit and County Court (SEAL) By______________________________________ Deputy Clerk/Notary Public ____ Personally Known My Commission Expires: ____ Produced Identification 2000 © American LegalNet, Inc. Affidavit Page 2 of 2 Type of identification presented:______________________________ REV. 08/97 123.doc (08/97) 2000 © American LegalNet, Inc.