Lake Charles City Court
AFFIDAVIT
STATE OF LOUISIANA PARISH OF CALCASIEU SUIT NUMBER: ________
Before me, the undersigned authority, duly qualified in and for the aforesaid parish and state personally came and appeared ____________________________ , phone #: _____________________ who declared unto me that they are located at: _______________________________ and that ___________________________ of _______________________________ is indebted to said petitioner in the amount $_______ for _______________________
Basis of Suit: ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ After amicable demand, the defendant has failed to pay. Therefore the plaintiff, __________________, is asking for the sum of $ _______ with interest from the date of Judicial Demand and all costs of court.
And that the said debtor has made no effort to pay same in spite of amicable demands.
______________________________
PETITIONER
Sworn to and subscribed before me this ___ day of ______, 2006.
______________________________
DEPUTY CLERK OF COURT