O.C.G.A. § 18-4-71 (2019)

“IN THE

STATE OF GEORGIA ) Plaintiff: ) ) ) Name ) ) Plaintiff’s contact information: ) ) ) Name ) ) Civil Action File No. Street Address ) ) City State ZIP Code ) ) E-mail Address ) ) Phone Number ) ) Bar Number ) ) v. ) ) Defendant: ) ) ) Name ) ) Street Address ) ) City State ZIP Code ) ) Garnishee: ) ) ) Name ) ) Street Address ) ) City State ZIP Code )

AFFIDAVIT OF GARNISHMENT □ Check this box if the Garnishee is a financial institution. □ Check this box if garnishment is for the collection of child support or alimony. See O.C.G.A. § 18-4-50, et seq. Personally appeared , who on oath says: (Print name) 1. I am the (Plaintiff) (Attorney at Law for Plaintiff) (Agent for Plaintiff). [Circle one] 2. The Plaintiff obtained a judgment against the Defendant in Case Number in the Court of County, , and State no agreement requires forbearance from the garnishment which is applied for currently. 3. $ is the balance due, which consists of the sum of $ Principal, $ Postjudgment interest, and $ Other (e.g., prejudgment interest, attorney’s fees, costs [exclusive of the cost of this action]). 4. Upon the Affiant’s personal knowledge or belief, the sum stated herein is unpaid. This day of

, 20 . Affiant Print name of Affiant Sworn to and subscribed before me this of , 20 . Notary Public or Deputy Clerk of Court”