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(deponent)

General form of affidavit

Defendant

Sworn by This is the

(1st, 2nd, etc.)

on affidavit by this deponent

Claimant

(date filed)

(2)

Address

In the Court
make oath and say as follows:(3)

(3)

Set out in numbered paragraphs, the facts deposed to.

Claim No.

Sworn at County of this day of

in the [19 ][20 ]

Before me
N285 - w3 General form of affidavit (4.99)

Officer of a Court, appointed by the Judge to take Affidavits.

Printed on behalf of The Court Service

(1) Full names and occupation of deponent.

I (1) of (2)

filed on behalf of
(party)

on