Sworn Statement of Account

State of:
County of:

Be it remembered, that on this day of , , before me, the undersigned Notary Public, in and for said County and State, duly commissioned and qualified, personally appeared who being duly sworn, deposeth and saith that (s)he is a member of the firm of and that the annexed account exhibiting the sum of $, against is just and true as stated; that has not received any part of the money stated to be due, or any security or satisfaction for the same, that all just credits have been given; and, additionally, that the contractual document provides for reasonable attorney fees and interest.

Affidavit

To the best of my information and belief under penalty of perjury, after investigation of Defendant's employment, I hereby make affidavit that the Defendant (please circle choice) is / is not a member of a military service.

By:
Title:

Sworn to and subscribed before me. In witness whereof I have hereunto set my hand and affixed by official seal in the City of , .
City State

Notary Public:
My Commission Expires: