RSCC-15B-E (2014/01)

ONTARIO Superior Court of Justice Affidavit

Form 15B Ont. Reg. No.: 258/98

Small Claims Court

Address

Phone Number

Claim No.

BETWEEN

Plaintiff(s)/Creditor(s)

and

Defendant(s)/Debtor(s)

My name is (Full Name)

I live in (Municipality and Province)

I make this affidavit in relation to:(Specify why the affidavit is being filed with the court.)

and I swear/affirm that the following is true: Set out the facts in numbered paragraphs. If you learned a fact from someone else, you must give that persons name and state that you believe that fact to be true.

Les formules des tribunaux sont affiches en anglais et en franais sur le site www.ontariocourtforms.on.ca. Visitez ce site pour des renseignements sur des formats accessibles.

RSCC-15B-E (2014/01)

Claim No.FORM 15B PAGE 2

If more space is required, attach and initial extra pages

Sworn/Affirmed before me at(Municipality)

in(Province, state or country)

on , 20Commissioner for taking affidavits

(Type or print name below is signature is illegible.)

Signature

(This form is to be signed in front of a lawyer, justice of the peace, notary public or commissioner for taking

affidavits.)

WARNING: IT IS AN OFFENCE UNDER THE CRIMINAL CODE TO KNOWINGLY SWEAR OR AFFIRM A FALSE AFFIDAVIT.

Affidavit Form 15B - Page 1 Affidavit Form 15B - Page 1Affidavit Form 15B - Page 2

RSCC-15B-E (2014/01)

RSCC-15B-E (2014/01)

Affidavit Form 15B - Page 1

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Affidavit Form 15B - Page 1

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ONTARIOSuperior Court of Justice

Affidavit

Form 15B Ont. Reg. No.: 258/98

BETWEEN

and

My name is

I live in

I make this affidavit in relation to:

and I swear/affirm that the following is true:

Set out the facts in numbered paragraphs. If you learned a fact from someone else, you must give that persons name and state that you believe that fact to be true.

Les formules des tribunaux sont affiches en anglais et en franais sur le sitewww.ontariocourtforms.on.ca. Visitez ce site pour des renseignements sur des formats accessibles.

Affidavit Form 15B - Page 2

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normal

runScript

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FORM 15B

PAGE 2

If more space is required, attach and initial extra pages

Sworn/Affirmed before me at

in

on

, 20

(Type or print name below is signature is

illegible.)

(This form is to be signed in front of a lawyer, justice of the peace, notary public or commissioner for taking affidavits.)

WARNING: IT IS AN OFFENCE UNDER THECRIMINAL CODE TO KNOWINGLY SWEAR OR AFFIRM A FALSE AFFIDAVIT.

8.0.1291.1.339988.308172

Affidavit Form 15B

Affidavit

TextField1: Small Claims Court: Address: Phone Number: Claim Number: Between. Plaintiff(s) or Creditor(s): and. Defendant(s) or Debtor(s): My name is. Full Name.: Sworn or Affirmed before me at. Municipality.: I make this affidavit in relation to: (Specify why the affidavit is being filed with the court.): I swear/affirm that the following is true: Set out the facts in numbered paragraphs. If you learned a fact from someone else, you must give that persons name and state that you believe that fact to be true.: in. Province, state or country.: on. Day Month: Year : Commissioner for taking affidavits. Type or print name below is signature is illegible.: Signature. This form is to be signed in front of a lawyer, justice of the peace, notary public or commissioner for taking affidavits.: Save Form: Print Form: Clear Form: