Fill and Sign the Writ of Execution Form

Writ of Execution U NITED S TATES D ISTRICT C OURT DISTRICT OF __________ DIVISION Writ of Execution V. Case No ____________________________ (Complete the following if judgment was rendered in another district) District ___________________ Docket No ___________________ Date Entered ___________________ TO ANY UNITED STATES MARSHAL IN THE STATE OF _________ : WHEREAS, on the ____ day of _________, A.D., _____ in a cause styled as above, judgment was rendered in this Court, or other United States District Court as indicated above and registered herein, in favor of ______________________________________________________________________________ _____________________________________________________________________________________ against ________________________________________________________________________________, hereinafter called judgment debtor, for the sum of $___________ with interest thereon at the rate of ____ percent per annum from the ____ day of ________, A.D. , ______ until paid, together with costs which have been taxed to date by the Clerk of Court in the sum of $___________________ ; AND WHEREAS, according to an affidavit on the reverse side hereof, executed by or in behalf of the judgment creditor, there remains due and unpaid the following sums: $ _____________ Unpaid balance of costs specified hereinabove taxed by the Clerk of Court $ _____________ Judgment $ _____________ Interest on Judgment and further interest will accrue on the unsatisfied judgment in the sum of $ _______________ per day from date of the aforesaid affidavit; THEREFORE YOU ARE COMMANDED, that of the goods and chattels, lands and tenements of the said judgment debtor you cause to be made the full amount of said judgment, interest, and costs, with the further costs of executing this writ. HEREIN FAIL NOT, and have you the said monies, together with this writ, before this Court within ninety (90) days from the date of this writ. WITNESS my hand and the seal of this Court on this ____ day of __________, 20_____. X ________________________________, CLERK By: _________________________________ Deputy Clerk AFFIDAVIT AND REQUEST FOR ISSUANCE OF WRIT OF EXECUTION I, __________________________, judgment creditor or duly authorized agent or attorney acting in the capacity specified under my signature, do hereby swear or affirm that all of the recitals on the reverse side of this instrument relating to the entry of judgment and costs are true and correct; and, after application of all credits, first against costs, second against accrued interest, and third against the judgment as entered, there remains unpaid and unsatisfied the sums specified, and that further interest will accrue as shown. Dated this ____ day of __________, A.D., _____. Signature and capacity in which signed: _____________________________ _____________________________ Address: _____________________________ _____________________________ Telephone Number: _____________________________ STATE OF ___________________ COUNTY OF ___________________ On this date there appeared before me, the undersigned authority, the person whose name is subscribed to the foregoing instrument and on his oath did swear or affirm that he has knowledge of the facts stated therein, that such facts are true and correct, and that he has authority to execute the instrument in the capacity stated therein. Date: ________________ _____ ____________________________ (SEAL) _________________________________ Title MARSHAL'S RETURN Received this writ at ________________________________________ , on _________________________ and executed as follows: _________________________________ UNITED STATES MARSHAL By __________________________ Deputy Marshal