Checklist For Submitting Page 4
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4STATE OF SOUTH CAROLINA
)
)
COUNTY OF COLLETON
)
IN THE FAMILY COURT
TH
)
OF THE 14
)
JUDICIAL CIRCUIT
IN THE INTEREST OF:
)
)
__________________________________ )
_____ - JU – 15 - ______
)
DOB:_____________________________
)
AFFIDAVIT
PERSONALLY appeared before me, Wilmont Hayes, who being duly sworn says that he
is the District Attendance Coordinator for Colleton County Schools and says that
____________________________________ has violated his/her Court Order dated
________________________ in the following manner:
1. ___________________________ has unexcused absences on the following days.
____________________________________________________________________
____________________________________________________________________
(See Attached Attendance Report)
or
2. _______________________ was suspended from school on _________________
for _______________________________________________________________
__________________________________________________________________
(See Attached Discipline Report)
______________________________
Signature of Affiant
SWORN to and subscribed before me
this______ day of ___________________ 20____
_________________________________________
Notary Public of South Carolina
My Commission Expires:____________________
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