IN THE CHANCERY COURT OF TENNESSEE FOR THE THIRTIETH JUDICIAL DISTRICT AT MEMPHIS ______________________________ Plaintiff VS. Docket No. _____________________ ______________________________ Defendant CREDITOR’S AFFIDAVIT, STATEMENT OF JUDGMENT DEBTOR’S LAST KNOWN ADDRESS AND REQUEST FOR ISSUE OF EXECUTION Pursuant to TCA 26-2-402, I, ___________________________________________, judgment creditor, creditor’s agent; or, attorney, being duly sworn, state that a judgment has been granted in the above styled case; that execution is requested based on an Order entitled: _______________________________________________________________________ _______________________________________________________________________ The Date of Order / Judgment is: _________________________________________ and a copy of said order is attached as an exhibit to this affidavit. That the amount of the judgment is: . Damages Cost Child Support Alimony Attorney Fee Other __________________ Amount _________________ _________________ _________________ _________________ _________________ _________________ _________________ That the Judgment Debtor is (Last Name, First Name, Middle): Whose Address is : ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ______________________________________________________________; American LegalNet, Inc. www.USCourtForms.com And whose SSAN / EIN is: That the Judgment Creditor is : the judgment creditor’s address for mailing any notice under this act is: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ _______________________________________________________________. That execution is requested against : q Wages (garnishment) (Sheriff’s fee $22.00 and Clerk’s Fee $25.00 attached) q Bank Account(s) (levy) (Sheriff’s fee $22.00 and Clerk’s Fee $25.00 attached) q Personal Property (attachment) (Sheriff’s fee $22.00 and Clerk’s Fee $25.00 attached): Description: ___________________________________________________ ___________________________________________________ Located at _____________________________________ _____________________________________ q Other _________________________________________________________ __________________________________________________________________, The Name and Address of Garnishee/Holder of Property is: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________ I further state that the amount of interest owed is ____________________; and, the total balance of judgment and interest owed is: $________________. _________________________________ Creditor/Agent/Attorney (BPR No.) Typed or Printed Name __________________________________ Address: _____________________________ __________________________________ Phone No. ___________________________ State of Tennessee County of Shelby ] ] Sworn to and Subscribed before me by ______________________________ who appeared before me this _________ day of ______________ , 20___________. _______________________________________ Notary Public My commission expires _____________________________ American LegalNet, Inc. www.USCourtForms.com