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Plaintiff
AND
Defendant
__________
Plaintiff/ Defendant, state the relationship with or job title with the Plaintiff/
Defendant.]
Summons filed on [date]. The facts deposed to herein are true to the best of
3. [Set out the facts that you have personal knowledge of in a convenient and
2
HCA No. __________ OF 200___
BETWEEN
Plaintiff
AND
Defendant
__________
__________________________________
AFFIDAVIT/ AFFIRMATION OF
[NAME]
_______________________________
Filed on
Name
Plaintiff/ Defendant in person
Address for Service