Affidavit And Agreement Small Claims {MJ-SC-012}

STATE OF MAINE DISTRICT COURT Location: Docket No.: Judgment Creditor v. Judgment Debtor I, Judgment Debtor, , in the capacity of for the , being duly sworn, depose and say: AFFIDAVIT AND AGREEMENT (14 M.R.S. § 3125(2)) 1. Judgment Debtor is a: Corporation Limited Liability Company Limited Liability Partnership Limited Partnership Nonprofit Corporation Other: 2. Judgment Debtor's gross income $ per 3. Judgment Debtor's net profit $ per 4. Judgment Debtor is under a court order to pay the following debts: DEBT OWED TO AMOUNT OF PERIODIC INSTALLMENT $ per $ per $ per per commencing TOTAL AMOUNT OWING $ $ $ . . 5. Judgment Debtor agrees to pay $ to Date: . Signature: Title: and made Personally appeared the above-named oath that the foregoing statements are true. Date: Notary Public/Clerk/Attorney AGREEMENT The Judgment Creditor agrees to the entry of an order requiring the judgment debtor to make installment payments of $ per payable to commencing on . Date: (Attorney for) Judgment Creditor MJ/SC-012, Rev. 05/13 American LegalNet, Inc. www.FormsWorkFlow.com