COC-CV- 06 ORIGINATED 08/29/00 FRANKLIN COUNTY, OHIO COMMON PLEAS COURT CLERK'S OFFICE-CIVIL DIVISION 345 S. HIGH ST. FIRST FLOOR COLUMBUS, OHIO 43215-4579 Judgment Creditor(s) AGAINST Judgment Debtor(s) Case No. (This number must be used on all references) AFFIDAVIT OF THE JUDGMENT CREDITOR AS IT RELATES TO THE CURRENT BALANCE DUE ON GARNISHMENT ORDER THE ORIGINAL JUDGMENT AMOUNT $ ACCRUDED INTEREST TO DATE $ COURT COST ASSESSED TO DATE $ AMOUNT PAID BY THE JUDGMENT DEBTOR TO THE JUDGMENT CREDITOR FOR THIS JUDGMENT TO DATE $ CURRENT BALANCE DUE $ DATE OF THIS AFFIDAVIT STATE OF OHIO, FRANKLIN COUNTY, SS: The undersigned being first duly cautioned and sworn, or affirmed, according to law says that I am the attorney/judgment creditor and that the information provided herein is an accurate representation of the status of the judgment owed by this debtor to this creditor for this judgment as of the date indicated above, and that I have served a copy of this affidavit, "Notice to the Judgment Debtor" and "Request For Hearing" upon the debtor in accordance with the provisions of O.R.C. Section 2716.031 as evidenced by the attached certificate of service. ATTORNEY OR CREDITOR'S NAME (Print or Type) ATTORNEY REGISTRATION NO. AFFIANTS SIGNATURE SWORN TO AND SUBSCRIBED BY ME ON THIS DAY OF , 20 NOTARY PUBLIC ***ATTACH THE CREDITOR'S CERTIFICATE OF SERVICE TO THIS AFFIDAVIT*** American LegalNet, Inc. www.FormsWorkFlow.com