IN THE GENERAL SESSIONS COURT OF MADISON COUNTY, TENNESSEE PLANTIFF -VS- DOCKET # DEFENDANT SS# STATEMENT FOR JUDGMENT CREDITOR REQUESTING GARNISHMENT OR EXECUTION STATE OF TENNESSEE, MADISON COUNTY , JUDGMNT CREDITOR, MAKES OATH THAT THE FOLLOWING DEBTOR222S LAST KNOWN ADDRESS: HOME ADDRESS PLEASE CHECK ONE: PLACE OF EMPLOYMENT: OR BANK JUDGMENT AMOUNT205205 $ LESS PAYMENTS 205205205205$ PRE-PAID COST205205205205... $ INTEREST205205205205205205205. $ GARNISHMENT AMOUNT.$ AND THE JUDGMENT CREDITOR222S ADDRESS FOR MAILING ANY NOTICES REQUIRES BY TITLE 26, CHAPTER 2, PART 4 OF TENNESSEE CODE ANNOTED IS : JUDGMENT CREDITOR SWORN TO AND SUBSCRIBED BEFORE ME THIS DAY OF, 20. NOTARY PUBLIC/CLERK(OR DEPUTY) DATE OF JUDGMENT American LegalNet, Inc. www.FormsWorkFlow.com