IN THE COUNTY COURT OF POLK COUNTY, FLORIDA
CASE NO. ____________________________
A F F I D A V I T
STATE OF FLORIDA
COUNTY OF POLK
BEFORE ME, the undersigned authority, personally appeared ________________________________________, the above named plaintiff, who, after being duly sworn, deposes and says:
1. On __________________________________, the plaintiff was awarded a judgment against the defendant in execution, _____________________________________________________________________________, in the sum of $____________ plus court costs of $____________ and interest; and
2. A Writ of Execution has been placed in the hands of the Sheriff of ________________ County, the county in which the defendant in execution resides and the Writ of Execution is valid and outstanding and remains unsatisfied; and
3. In accordance with the provisions of Florida Statute 56.29, the plaintiff requests proceedings supplementary to execution.
SWORN TO and subscribed before me this _____ day of _____________________, 19____.
RICHARD M. WEISS, CLERK
Circuit and County Court
Deputy Clerk/Notary Public
____Personally Known My Commission Expires:
Type of identification presented:______________________________
REV. 08/97123.doc (08/97)