Georgia Code Title 18. Debtor and Creditor § 18-4-71

“IN THE COURT OF COUNTY

STATE OF GEORGIA

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Plaintiff:

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_________________________________________________

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Name

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Plaintiff's contact information:

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_________________________________________________

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Name

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_________________________________________________

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Civil Action File No._____________________

Street Address

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_________________________________________________

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City

State

ZIP Code

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_________________________________________________

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E-mail Address

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_________________________________________________

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Phone Number

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_________________________________________________

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Bar Number

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Defendant:

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_________________________________________________

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Name

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_________________________________________________

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Street Address

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_________________________________________________

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City

State

ZIP Code

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Garnishee:

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_________________________________________________

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Name

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_________________________________________________

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Street Address

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_________________________________________________

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City

State

ZIP Code

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Personally appeared

____________________________________________________

, who on oath says:

(Print name)

1. I am the (Plaintiff) (Attorney at Law for Plaintiff) (Agent for Plaintiff). [Circle one]

2. The Plaintiff obtained a judgment against the Defendant in Case Number____________

in the ________________________

Court of ______________________

County, __________________________,

and no agreement requires forbearance from the garnishment which is applied for currently.

3. $__________ is the balance due, which consists of the sum of $__________ Principal, $__________ Postjudgment interest, and $__________ Other (e.g., prejudgment interest, attorney's fees, costs [exclusive of the cost of this action]).

4. Upon the Affiant's personal knowledge or belief, the sum stated herein is unpaid.

This __________ day of______________________________, 20___.

___________________________________

Affiant

___________________________________

Print name of Affiant