Small Claims Form 3. 2 7 : Verification of Account, Identification of Judgment Debtor, and Certificate Re Military Service In the Iowa District Court for County Plaintiff(s) (Name) (Name) vs. Defendant(s) (Name) (Name) Verification of Account, Identification of Judgment Debtor, and Certificate Re Military Service Small Claim No. For defendant: (This form required for each Defendant.) 1. I, , am a party or an employe e of Plaintiff (s) whose claim (s) is (are) shown i n the attached statement(s) . I have personal knowledge that the attached statement (s) is (are) a true copy of the original creditor s records showing the balance due is true and correct. I further state that the sum of $ is the balance due and owing as of from Defendant(s) to Plaintiff(s) and any interest amou nt owing is accurately stated in the Petition or Original Notice. 2. I further state that D efendant reside s at , i s employed at , and is . 3 . Check A, B, or C for Defendant A. Defendant is not in the military service of the United States government, I have verified this fact by (check one): C heck ing the Defense Manpower Data Center (DMDC) (requires name and SSN or name and date of birth) . C ontact ing D efendant who informed me. R egularly see ing D efendant and believ ing Defendant is are not active in the U.S. military . O r B. I have investigated, and I am unable to determine whether or not Defendant is in the military service of the United States government O r C. Defendant is in the military service of the Uni ted States government 4 . I also state to the best of my knowledge (check one): Defendant is under a disability or confined in a reformatory, jail, or penitentiary. Defendant is not under a disability or confined in a reformatory, jail, or penitentiary I certify under penalty of perjury and pursuant to the laws of the State of Iowa that these facts are true and correct. Date: Signature of Affiant /s/ Phone number Filing Plaintiff or Attorney Email address Law firm, or entity for which filing is made, if applicable Additional email address, if applicable Mailing Addres s American LegalNet, Inc. www.FormsWorkFlow.com