IN THE GENERAL SESSIONS COURT OF MADISON COUNTY, TENNESSEE ___________________________________________ PLANTIFF -VS___________________________________________ DEFENDANT DOCKET #___________________ ___________________________________________ SS# STATEMENT FOR JUDGMENT CREDITOR REQUESTING GARNISHMENT OR EXECUTION STATE OF TENNESSEE, MADISON COUNTY __________________________________, JUDGMNT CREDITOR, MAKES OATH THAT THE FOLLOWING DEBTOR’S LAST KNOWN ADDRESS: HOME ADDRESS_________________________________________________________________________ _________________________________________________________________________ PLEASE CHECK ONE: ________ PLACE OF EMPLOYMENT: _______________________________________________________________ OR ________ BANK _______________________________________________________________ _______________________________________________________________ JUDGMENT AMOUNT…… $_______________________ LESS PAYMENTS …………$_______________________ PRE-PAID COST…………... $_______________________ INTEREST…………………. $_______________________ GARNISHMENT AMOUNT.$_______________________ AND THE JUDGMENT CREDITOR’S 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