Mississippi Code Title 11. Civil Practice and Procedure § 11-7-181

A person indebted to another in any sum of money within the jurisdiction of the circuit court, on any promise, agreement, or covenant, may sign an office confession of judgment in the clerk's office of the circuit court, in the manner following, to wit: The creditor shall file in the clerk's office a statement, under oath, substantially to the effect following, viz.:

“The State of Mississippi, __________ County.

In the circuit court of said county, ___ day of __________, A.D. __________.__________ states, on oath, that __________ is justly indebted to him for the amount of __________ dollars on an instrument of writing in the following words and figures, viz.: (here copy the same), and in case of indorsement say indorsed as follows: (here copy the indorsement), or on open account, of which a copy is hereto attached, which remains due and unpaid, and that said sum of money is not due or claimed under a fraudulent or usurious consideration.

“Sworn to and subscribed the ___ day of __________ A.D.__________ before me. “__________, Clerk.”

And if the evidence of the debt be in writing, the same shall be filed with said statement; and if not in writing, then a copy of the open account shall be filed; and the party indebted shall sign, before the clerk, an acknowledgment written upon or annexed to such statement, to the effect following, to wit:

“I do hereby acknowledge myself indebted to the said __________ in the sum of __________ Dollars, which includes interest up to the first day of the next term of the said circuit court, and I give my consent for judgment to be rendered against me in favor of said __________, at the next term of said circuit court for said amount and all legal costs accruing thereon, with stay of execution (if any) until (as may be agreed upon).

“Taken and acknowledged the ___ day of ___, A.D. ___, before me.