) ) STATE OF SOUTH CAROLINA ) ) COUNTY OF ____________________ ) ) _____________________________________ ) PLAINTIFF(S) ) ) VS. ) ) _____________________________________ ) DEFENDANT(S) )
__________________________ CIVIL CASE NUMBER IN THE MAGISTRATE'S COURT
AFFIDAVIT OF PLAINTIFF (Distraint)
I, ___________________________________ plaintiff in this action, state that I am the landlord-lessor of premises within the jurisdiction of Magistrate _________________________, which are described as (address and description of premises apartment, house, etc.): ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ I further state that, with regard to the above described premises, a landlord-tenant relationship exists between myself and the defendant, ________________________________, tenant-lesses, as evidenced by the following: (Attach lease papers or other written proof.) ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ and that the defendant is delinquent in his rent payment, in the amount of $______________. (Describe in detail amounts due and on what dates.) ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Sworn to before me this day of ) ) ) ) ) ) )
, 2
.
Notary Public for South Carolina My Commission expires SCCA/735 (Amended 05/2008)
PLAINTIFF (or his attorney)