STATE OF INDIANA      )                                                              IN THE _______________ COURT

                                                )  SS:                                                      DIVISION _________________________

COUNTY OF _______       )                                                              SITTING AT ______________________

                                                                                                                ___________________________________________

                                                                                                                                CASE NUMBER

                                                                        )

            PLAINTIFF                                         )

v.                                                                     )           AFFIDAVIT FOR IMMEDIATE

                                                                        )                       POSSESSION

                                                                        )

            DEFENDANT                                     )

                COMES NOW ___________________________________________ and files with the Clerk of the Lake County Court, this affidavit and states that he is the owner of property situated at _______________

_________________________________________________________________________, now occupied by the defendant, __________________________________________, who is occupying said property wholly without right after having received due notice to vacate said premises.  That said premises has a reasonable rental value of __________________ per month or week and that the defendant is delinquent in his rent in the amount of __________________________, having wholly failed and refused to pay the rent for the months (or weeks) of _________________________________________________________________.

                The undersigned verily believes that unless the defendant is restrained and that unless the court holds an immediate hearing that the defendant will be irreparable damage to the property in the form of waste and that it is necessary an immediate hearing be head in order to protect said premises from irreparable damage.

                I, ___________________________________________, affirm, under the penalties for perjury, that the foregoing representations are true.

                                                                                                _____________________________________________________

                                                                                                                PLAINTIFF’S SIGNATURE