AFFIDAVIT PROVIDING 
DOCUMENTATION OF DEBT 
Mass. R. Civ. P. 8.1(d)

DOCKET NO. 

Trial Court of Massachusetts

COUNTY/COURT DIVISION

PLAINTIFF

DEFENDANT

THIS FORM IS REQUIRED IN ALL CASES SUBJECT TO MASS. R. CIV. P. 8.1

 The affiant states that the following documents are attached to this affidavit:

1.  DOCUMENTS ESTABLISHING THE EXISTENCE, AMOUNT, AND TERMS AND CONDITIONS 
     APPLICABLE TO THE DEBT THAT IS THE SUBJECT OF THIS ACTION, INCLUDING:

  A. A document provided to the defendant before the date of charge-off demonstrating the defendant

incurred the debt and the amount owed.

  B. Documents establishing the terms and conditions applicable to the debt.

  C. The written document, if any, signed by the defendant evidencing the defendant's agreement to
the terms and conditions described in the documents referenced in B above, or, if a signed copy of 
such document is not within the possession, custody, or control of the plaintiff, documents 
evidencing the defendant's acceptance of such terms and conditions (which may include the most 
recent monthly statement reflecting a purchase, payment, or balance transfer authorized by the 
defendant before the date of charge-off).

 Other document(s) establishing the existence, amount, and terms and conditions of the debt, if any:

2.  DOCUMENTS REGARDING OWNERSHIP OF DEBT:

 Each bill of sale, assignment, or other document evidencing the transfer of ownership of the debt, 
beginning with the original creditor. (Such documentation must include a specific reference to the 
defendant or the defendant's account number.)

 Not Applicable - plaintiff is the original creditor. 

The name, position, and employer of the affiant:

SIGNED UNDER THE PENALTIES OF PERJURY
AFFIANT

DATE

X

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