Affidavit And Itemization Of Accounts

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CIVIL CASE NUMBER
STATE OF SOUTH CAROLINA
)
)
IN THE MAGISTRATE’S COURT
COUNTY OF _______________________
)
)
_____________________________________
)
PLAINTIFF(S) )
)
AFFIDAVIT AND ITEMIZATION
VS.
)
OF ACCOUNTS
)
_____________________________________
)
DEFENDANT(S) )
Plaintiff, ________________________________________, personally appearing before
me, who, being duly sworn, states that he is the plaintiff in this action, and that the itemization of
accounts which follows is true and correct.
He further states that no part of the sum included in the itemization below has been paid
or satisfied in any fashion, and is today due and owed to him.
ITEMIZATION OF ACCOUNTS
________________________________________________
$___________
________________________________________________
$___________
________________________________________________
$___________
________________________________________________
$___________
________________________________________________
$___________
TOTAL
$___________
(Copies of bills, papers or other proof of any of the above accounts should be attached to this document.)
Sworn to and Subscribed before me
)
this
day of
, 2
. )
)
)
Magistrate or Notary Public for South Carolina
)
PLAINTIFF (or his attorney)
)
My Commission expires
)
SCCA/716 (Amended 05/2008)

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