Affidavit For Immediate Possession Form - Indiana Noble Superior Court Division 2
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1AFFIDAVIT FOR IMMEDIATE POSSESSION
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NOBLE SUPERIOR COURT DIVISION 2
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SMALL CLAIMS - 3rd Floor Court House
101 North Orange St., Albion, Indiana 46701
Court 260-636-2129 Clerk 260-636-2736
STATE OF INDIANA }
COUNTY OF NOBLE}
CLAIM NUMBER ___________________________________
______________________________________________________________
_______________________________________________________________
Plaintiff Name
Plaintiff Name
______________________________________________________________
_______________________________________________________________
Street Address
Street Address
______________________________________________________________
______________________________________________________________
City, State, Zip
City, State, Zip
Phone _________________________________________________________
Phone _________________________________________________________
VS
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_______________________________________________________________
______________________________________________________________
Defendant Name
Defendant Name
_______________________________________________________________
______________________________________________________________
Street Address
Street Address
_______________________________________________________________
______________________________________________________________
City, State, Zip
City, State, Zip
Phone _________________________________________________________
Phone _________________________________________________________
AFFIDAVIT FOR IMMEDIATE POSSESSION
Comes now ____________________________________ and files with the Clerk of the Noble County Courts, this affidavit and
state that he/she is the owner of the property situated at:
______________________________________________________________________________________________________
now occupied by the defendant(s), __________________________________________________________________________
who is occupying said property wholly without right after having received due Notice to Vacate said premises. That said
premises has a reasonable rental value of $ _________________ per month or week and that the defendant is delinquent in
his/her rent in the amount of $_________________. Having wholly failed and refused to pay the rent for the months or weeks of
__________________________________________________________________________________________________.
The undersigned verily believes that unless the defendant is restrained and that unless the Court holds an immediate hearing
that the defendant will do irreparable damage to the property in the form of waste and that it is necessary that an immediate
hearing be had in order to protect said premises from irreparable damage.
Immediate Possession Hearing set for the ________ day of ____________________ 2 0 _____ at ____________ ____m,
___________________________________________
Plaintiff (signature)
Subscribed and sworn before me, a Deputy Clerk or Notary Public this
___________ Day of ________________________, 20_____
__________________________________________________
Deputy Clerk / Notary Public
My Commission Expires:
Revised 7/06
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