STATE COURT OF GWINNETT COUNTY P.O. Box 568, Lawrenceville, GA 30046-0568 (770) 822-8100 Plaintiff: O.C.G.A. § 18-4-71 Address: State Court Garnishment Case No.: _____________________ GARNISHMENT ON A FINANCIAL INSTITUTION Phone #: Plaintiff's Attorney: VS Defendant: Address: Garnishee: Address: AFFIDAVIT ( ) Check this box if the Garnishee is a financial institution. ( ) Check this box if garnishment is for the collection of child support or alimony. See OCGA. § 18-4-50 et. seq. Personally appeared [Print Name] who on oath says: 1. I am the (Plaintiff) (Attorney at Law for Plaintiff) (Agent for Plaintiff). [Circle one] 2. The Plaintiff obtained a Judgment against the Defendant in Case Number the Court of County, , in [State], and no agreement requires forbearance from the garnishment which is applied for currently. 3. $ ___ is the total balance due, which consists of the sum of: $ $ _____ Principal; Post Judgment Interest; and $_________________Other (e.g., prejudgment interest, attorney's fees, costs [exclusive of the costs of this action]). 4. Upon the Affiant's personal knowledge or belief, the sum stated herein is unpaid. Sworn to and subscribed before me This day of , 20 This ___________ day of _________________, 20___. . Notary Public/Deputy Clerk of Court Richard T. Alexander, Clerk of Court APPROVED AS TO FORM: ______________________________________________ Deputy Clerk of Court Affiant Print Name of Affiant American LegalNet, Inc. www.FormsWorkFlow.com