STATE OF SOUTH CAROLINA COUNTY OF CHARLESTON IN THE MAGISTRATES COURT ____________________________ ____________________________ PLAINTIFF AFFIDAVIT AND TELEPHONE:______________ COMPLAINT IN vs. CLAIM AND DELIVERY _____________________________ _____________________________ DEFENDANT Plaintiff, _______________________________________ personally appearing before me, who being duly sworn, states the following: 1. The plaintiff is the owner, or is entitled to possession, of the property described below: _____________________________________________________________________________________ ____________________________________________________________________________________ _______________________________________________________________________________________ 2. The property described above is being wrongfully withheld by the defe_________________.ndant, 3. To the best knowledge of the plaintiff, the property is being withheld by the defendant because: ____________________________________________________________________________________. 4. The property was not/was taken from the ownership or possession of the plaintiff due to any tax, fine or assessment (and if seized, it should not have been seized by virtue of its exempt status). 5. The actual value of the above described property is: (Itemize and give total if more than one item is involved.) ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Total $______________________. This amount has beednete rmined in the following manner, to wit: ______________________________________________________________________________ _________________________________________________________________________________ 6. That the Notice of Right to Cure as required by Section 37-5-110 and Section 37-5-111, Code of Laws of South Carolina, 1976, as amended, has been given by_______________________________. DATED_______________ ____________________________ Plaintiff SWORN TO BEFORE ME THIS ____ DAY OF________________ 20____ ____________________________________ MAGISTRATE OR NOTARY MY COMMISSION EXPIRES:___________