AFFIDAVIT TO SUPPORT Case Number
Tennessee DEFAULT JUDGMENT
_________________________________________ vs. _____________________________________
STATE OF ________________________
COUNTY OF ______________________
After first being sworn, I state that I am competent to give this Affidavit and am giving it
from my personal knowledge, as follows:
1. I am 18 years of age or older, and I am the Plaintiff in this case, or the Plaintiff in this case is
a business organization and I am an owner, officer, or employee of the Plaintiff.
2. To my knowledge and belief, the Defendant is not in the uniformed services as defined by
the Servicemembers Civil Relief Act of 2003.
4. I have attached copies of all relevant documents to this affidavit.
5. The Defendant owes the Plaintiff: $ _______________
Deduct payments made since the date of filing: _______________
Add fees for filing claim and service of process: ____________
TOTAL DUE AND OWING $ _______________
3. This claim does does not include interest, finance charges, or late charges. If not, the
amounts are calculated as follows: ______________________________________________
Dated: __________________, 20____ ________________________________________
Telephone: _______________ Fax: ___________________ E-Mail: _____________________
Personally appeared before me, the undersigned, a notary public in and for this county and state,
the person named above with whom I am personally acquainted (or who proved his or her
identity to me on the basis of satisfactory evidence) and who acknowledged that he or she
executed this instrument for the purposes contained in it.
Witness my hand and official seal this day of ______, 20___.
My Commission Expires: