Full Name of Party Filing Document Mailing Address (Street or Post Office Box) City, State and Zip Code Telephone Email Address (if any) IN THE DISTRICT COURT FOR THE JUDICIAL DISTRICT FOR THE STATE OF IDAHO, IN AND FOR THE COUNTY OF SMALL CLAIMS DEPARTMENT Case No. , Plaintiff(s), vs. AFFIDAVIT OF NON-COMPLIANCE , Defendant(s). I, (print your name) penalty of perjury that on (date agreement signed) party's name) , hereby certify under , (print other and I signed a Memorandum of Agreement. (print other party's name) has not complied with the Memorandum of Agreement by failing to do the following: AFFIDAVIT OF NON-COMPLIANCE CAO SC4-11 07/01/2016 PAGE 1 American LegalNet, Inc. www.FormsWorkFlow.com Or (print other party's name) the Memorandum Agreement by: has partially complied with Based upon these facts, I/We ask that Judgment be entered against the Defendant in the amount of $ . CERTIFICATION UNDER PENALTY OF PERJURY I certify under penalty of perjury pursuant to the law of the State of Idaho that the foregoing is true and correct. Date: Typed/printed name Signature AFFIDAVIT OF NON-COMPLIANCE CAO SC4-11 07/01/2016 PAGE 2 American LegalNet, Inc. www.FormsWorkFlow.com