In The State Court of Chatham County, Georgia ____________________________________________ _________________________________________ Plaintiff Versus ____________________________________________ ____________________________________________ Defendant ______________ Case Number DISTRESS WARRANT Personally appeared before the undersigned judicial officer ________________________________ who on oath says that she/he is (the agent for) the owner of the premises known as _________________________________________ that ________________________________ from said rented premises without the payment of rent. Sworn to and Subscribed before me by the Affiant this _____ day of _________________ 20___. the tenant of said premises; that said tenant is indebted to said Plaintiff in the sum of $______________ as rent; and/or that said tenant is about to remove his goods and chattels Affiant Judge, State Court of Chatham County, Georgia SUMMONS TO: ___________________________________________ Pursuant to Law, you are hereby notified to be in the Clerk's Office, State Court of Chatham County, Suite 308 Chatham County Courthouse, on ____________________, 20___, to answer in writing ("...on a day certain not less than five (5) nor more than seven (7) days from the actual date of service." O.C.G.A. 44-7-72) or to answer orally at said time, and to set forth whatever legal or equitable defense or any counter claim you may have to this distress warrant proceeding. This day of , 20 . Judge, State Court of Chatham County, Georgia 11. Distress Warrant Affidavit 09-05 American LegalNet, Inc. www.FormsWorkFlow.com