Petition: Eviction Case Form (Page 2 of 4) in pdf

6. SEC. 201(b) Servicemembers Civil Relief Act Affidavit: Plaintiff/agent being duly sworn on oath under penalty of

perjury (fine and/or up to one year in jail) deposes and says that the above-named defendant(s) (check one):

____ Is not subject to the Servicemembers Civil Relief Act of 2003 or a dependent of a servicemember.

____ Is on active military duty and/or is subject to the Servicemembers Civil Relief Act of 2003.

____ Defendant has waived his/her rights under the Servicemembers Civil Relief Act of 2003.

____ Servicemember status of defendant is unknown at this time.

REQUEST FOR JUDGMENT: Plaintiff prays that defendant(s) be served with citation and that plaintiff have

judgment against defendant(s) for:

____ Possession of premises, including removal of defendant(s) and defendant’s possessions

____ Unpaid Rent

____ Attorney’s Fees

____ Court Cost

____ Interest on the above sums at the rate stated in the rental contract, or if not so stated, at the statutory rate for

judgments under Civil Statutes Article 5069-1.05.

____Other:_________________________________________________________________________________

___________________________________________ ________________________________________________

Petitioner’s Printed Name

Signature of Plaintiff (Landlord/Property Owner) or Agent

________________________________________________

Address of Plaintiff or Agent

________________________________________________

City/State/Zip

________________________________________________

Phone & Fax No. of Plaintiff or Agent

Defendant’s Information (If Known):

Date of Birth:

____________

Last 3 Digits of Driver’s License: ____________

Last 3 Digits of Social Security: ____________

Phone Number:

____________

Fax Number:

____________

Email Address:

____________

THE STATE OF TEXAS

COUNTY OF LIBERTY

Subscribed and Sworn to before me this ______ day of _______________________, 20_____.

_________________________________________________

_____ Clerk of the Court

_____ Notary Public

Petition: Eviction Case Form Page 2