IN THE MAGISTRATE COURT OF LIBERTY COUNTY STATE OF GEORGIA A. Case Number: B. Plaintiff Name: C. Plaintiff Address/Phone Number: C. Defendant Name: E. Defendant Address/Phone Number: F. Relationship of Affiant to Plaintiff: ( ) Attorney ( ) Agent ( ) Lessee G. Party Premises Rented or Leased to (if not Defendant): H. Plaintiff's Demands: (1) Possession of the premises; (2) Past due rent in the amount of: (3) Rent accruing up to date of judgment or vacancy at rate of: (4) Other (enumerate; attach additional sheets if necessary): I. Date of Affidavit and Summons: J. Magistrate Judge: K. Hon. $ $ $ LAST DATE TO ANSWER: AFFIDAVIT FOR SUMMONS OF DISPOSSESSORY Personally appeared the above-named person, who states upon oath that he or she is the owner (or is acting in the capacity shown in (F) above on behalf of the Plaintiff) of premises Defendant is in possession of at the above address in Liberty County; Furthermore, Plaintiff states that Defendant: (a) Fails to pay the rent which is now past due; (b) Holds the premises over and beyond the term of which they were rented or leased to Defendant or the party named in (G) above; (c) Plaintiff is entitled to recover any and all rents that may come due until this action is finally concluded; (d) Plaintiff desires and demands possession of the premises; and (e) Defendant refuses and fails to deliver possession of the premises to the Plaintiff. WHEREFORE, Plaintiff demands relief as stated in (H) above. ______________________________________ Affiant Sworn and subscribed before me on the above-written date: ______________________________________ Notary Public/ Clerk or Deputy Clerk Liberty Magistrate Court American LegalNet, Inc. www.FormsWorkFlow.com SUMMONS To the Defendant in the above-styled action: GREETINGS: You are hereby commanded and required to make an answer to this action personally or by an attorney, orally or in writing, to the Clerk of the Magistrate Court, at the Liberty County Justice Center, 201 South Main Street, Suite 1200, not later than 4:30 p.m., on the above-stated last date to answer. If no answer is made, a Writ of Possession shall be issued as provided by law, and judgment shall be granted as demanded by the plaintiff named herein. The last possible day to file an answer is stated above. Witness the Clerk or Deputy Clerk of Liberty Magistrate Court on the date stated above. _________________________________ Clerk or Deputy Clerk Liberty Magistrate Court American LegalNet, Inc. www.FormsWorkFlow.com