IN THE COUNTY COURT OF POLK COUNTY, FLORIDA
CIVIL DIVISION
CASE NO. ________________________
Plaintiff ,
vs.
Defendant .
______________________________________/
AFFIDAVIT OF DEFAULT IN PAYMENT
STATE OF FLORIDA
COUNTY OF POLK
I, _________________ , after being placed under oath, do swear or affirm that the defendant agreed to make payments to the plaintiff in the amount of $________ weekly / monthly beginning on ____________, 19___. The defendant failed to pay as agreed, the last payment having been made on _______________, 19___. Accounting is as follows:
Principal amount stated on judgment $_______________
Plus attorney fees stated on judgment + $_______________
Plus court costs stated on judgment + $_______________
Plus interest stated on judgment + $_______________
Plus interest from date of judgment at ___% + $_______________
Less total payments received since judgment - $_______________
TOTAL AMOUNT DUE TO DATE $_______________
Plaintiff requests that the Court enter Final Judgment for the amount due, or in the event that a Judgment has been entered with Stay of Execution, that the Court remove the Stay of Execution.
Dated this _____ day of ________________, 19____.
_____________________________________
Plaintiff
Sworn to and subscribed before me this _____ day of _________________, 19____.
__ Personally Known RICHARD M. WEISS, CLERK
Circuit and County Courts
__
Produced IdentificationType of Identification By___________________________________
presented: _______________________________ Deputy Clerk/Notary Public
My Commission Expires:
O R D E R
The above captioned matter having come before the Court, and the Court having reviewed the Affidavit, it is
ORDERED AND ADJUDGED that JUDGMENT BE ENTERED/STAY OF EXECUTION BE REMOVED for the balance owing of $_____ plus $______ costs; and $______ interest that does not accrue interest.
DONE AND ORDERED this _____ day of ________, 19____.
____________________________
JUDGE OF THE COUNTY COURT
Copy to above parties.
Rev. 08/97 83.doc (08/97)
Rev. 08/97 83.doc (08/97)