Fill and Sign the Undersigned Affiant Applying for an Order of Attachment and Being First Duly Sworn Says that an Action Has Been or Form

Date Commission ExpiresThe nature of this action is as follows:has removed or is about to remove, property from this state. has assigned, disposed of, secreted, or is about to assign, dispose of, or secrete, property.a. b.has departed, or is about to depart from the state. keeps himself/herself concealed therein.A person or a domestic corporation which, with intent to defraud his/her or its creditors,5.a. b.A nonresident. A foreign corporation. A domestic corporation whose president, vice president, secretary or treasurer cannot be found in the state after due diligence. A resident of the state who, with intent to defraud his/her creditors, or to avoid service of summons1. 2. 3. 4. Original-File Copy-Each Defendant Copy-Attorney/Plaintiff (Over)STATE OF NORTH CAROLINAAFFIDAVIT IN ATTACHMENT PROCEEDING CountyVERSUS G.S. 1-440.8, 1-440.10, 1-440.11The undersigned affiant, applying for an order of attachment and being first duly sworn, says that an action has been or is about to be commenced to secure a judgment for the amount and purpose indicated below and that the plaintiff is entitled to recover the amount for which judgment is sought over and above all counterclaims known to him/her.File No.The grounds for attachment are that the defendant is: (check one or more) In The General Court Of JusticeDistrictSuperior Court DivisionAgentSignature Of Affiant PlaintiffAttorney$SWORN AND SUBSCRIBED TO BEFORE MESignature SEALFilm No.Name Of PlaintiffName Of DefendantAmount SoughtThe facts and circumstances supporting allegations or acts committed with intent to defraud creditors are as follows:DateTitle Of Person Authorized To Administer OathsName Of Affiant (Type Or Print)AOC-CV-300, Rev. 4/971997 Administrative Office of the Courts PLAINTIFF'S BONDI, as principal, and the undersigned surety, do acknowledge that upon the issuance of this order of attachment we shall be bound to the defendant in the amount shown below. The condition of this bond is that if the order of attachment is thereafter dissolved, dismissed or set aside by the Court, or if I fail to obtain judgment against the defendant, I will pay all costs that may be awarded to the defendant and all damages that the defendant may sustain by reason of the attachment, provided that the liability of the undersigned surety shall be limited to the amount of this bond.Signature Of Surety 2Signature Of Plaintiff (Principal)Signature Of Surety 1AFFIDAVIT BY INDIVIDUAL SURETYThe undersigned surety, being first duly sworn, says that he/she is a resident of the State of North Carolina, and is worth the amount of the bond, over and above all liabilities and exemptions allowed by law.Signature Of Surety 2Signature Of Surety 1 $SWORN AND SUBSCRIBED TO BEFORE MESignature SEALDateAmount of BondName And Address Of Surety 2 (Type Or Print)Name And Address Of Surety 1 (Type Or Print)DateTitle Of Person Authorized To Administer OathsDate Commission ExpiresAOC-CV-300, Side Two, Rev. 4/97 1997 Administrative Office of the Courts