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Pca
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_SETUP.1
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POC.BLD
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1997-07-22
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3KB
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98 lines
#100
@001 Enter the name of the CREDITOR:
~Enter the full legal name of the creditor and, if applicable,
~the trade name. For example: Unknown Distributors, Inc., d/b/a
~Magic Supplies for Amateur Magicians.
@020 Enter the name of the DEBTOR:
~Enter the name of the person or firm who owes the creditor.
@002 Enter the name of the person completing the affidavit:
~Enter the name of the person who will sign the affidavit.
@003 Enter the title of the person completing the affidavit:
~Enter the title of the person signing the affidavit. For
~example: Assistant Credit Manager.
!004 Enter the present principal balance.
~Enter, in dollar format, the present balance due on account of
~principal.
!100 Enter the present balance of interest:
~Enter, in dollar format, the present balance due of interest or
~"service charges." If no interest is being charged enter: not
~applicable.
@101 Enter the interest rate used as a numeral:
~Enter as a numeral, the interest rate on the debt. If no
~interest is charged, enter 0.
|005 Enter the date when the balance was calculated:
~Enter the date when the balance was calculated. Normally same
~date as the affidavit is being signed.
@006 Enter the state where the affidavit is being completed:
~Enter the name of the state where the affidavit is being signed.
@007 Enter the county where the affidavit is being completed:
~Enter the name of the county, parish or judicial district where
~the affidavit is being signed.
#end control section
#100
AFFIDAVIT IN PROOF OF CLAIM
STATE OF @006
COUNTY OF @007
@002, being duly sworn to tell the truth, deposes, stating:
@002 is employed by @001 as @003. As @003 I am the custodian of
the business records of @001 and am familiar with the business
records of @001. @001 maintains records of its accounts with
others in the ordinary course of its business and such records
are created by employees with knowledge of the facts and
circumstances at the time that the records are created.
I have reviewed @001's records concerning the account with @020,
and the balance due and owing from @020 as of |005 is:
Principal: $!004 (!004 dollars)
Interest calculated at @101%: $@100 (!100 dollars)
Said balances stated are inclusive of all credits, offsets and
discounts.
FURTHER AFFIANT SAYETH NAUGHT
_______________________________________
@002
Sworn to and subscribed before me by @002 who did take an oath,
and who is:
____ personally known to me
____ produced the following identification:
______________________________________
My Commission expires: