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DISTRICT COURT OF MARYLAND FOR ....................................................................................................
City/County

Located at .............................................................................................. Case No.........................................................
Court Address

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Name

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Name

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Address

vs.

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Address

....................................................................................................
Plaintiff

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Defendant

PROPERTY DAMAGE AFFIDAVIT
(3-509)
I HEREBY CERTIFY: 1. I am a................................................................................................................. with the following training and/or experience ................................................................................................................................................................................................................
State sufficient facts to show qualification

............................................................................................................................................................................................................. . 2. 3. That the matters stated herein are affirmed on my personal knowledge. That attached is an o itemized repair bill o itemized estimate of the cost of repairing the damaged ........................................................................................................... of ............................................................................................ . 4. 5. 6. That the repairs or estimate were made o by me o under my supervision. That in my opinion the itemized repair bill or estimate is fair and reasonable. That in my opinion the fair market value of the property on ..................................................................................................................... immediately before the damage was $ ........................................................ and immediately after the damage and before repairs was $ ......................................... and after repairs is or will be $...................................................... . I solemnly affirm under the penalties of perjury and upon personal knowledge that the contents of the forgoing paper are true to the best of my knowledge, information, and belief. ....................................................................................................
Date

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Signature of Plaintiff

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DC/CV 20 (Rev. 8/2002)