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 Identification

          Type 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)