COMMONWEALTH OF MASSACHUSETTS
__________________,
SS: HOUSING COURT DEPARTMENT
_______________________
DIVISION
/ / /
SP-_ / / / / /
_____________________________________
Plaintiff/Landlord
VS.
______________________________________
Defendant/Tenant
NON MILITARY AFFIDAVIT AND AFFIDAVIT OF PAYMENTS MADE
1. The defendant(s) in the above captioned case is/are not believed in the military
service as defined in the Servicemember’s Civil Relief Act, and that I know this to
be true because: __________________________________
_______________
______________________________________________________________________________
______________________________________________________________________________
2. The defendant(s) has/have PAID rent (or use and occupation) in the amount of
$_____________________ since the action was commenced.
3. The defendant(s) still OWE rent (or use and occupation) in the amount of
$_________________ through _______________________________________________.
4. The defendant(s) still occupy/occupies the premises described in my Complaint
or, if the premises are no longer occupied, the defendant(s) vacated the premises
on _____________________________________________________________________.
Subscribed and sworn under the pains and penalties of perjury, this ____________ day of
____________________, 200____.
_____________________________________________
Signature of Plaintiff or Plaintiff’s Attorney
(select county)
(select court)
(select day)
(select month)
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