IN THE MAGISTRATE COURT OF CHATHAM COUNTY STATE OF GEORGIA

) ) ) ) Plaintiff(s), ) ) vs ) Civil Action No.: ) ) ) ) ) Defendant(s). ) I/we , the Plaintiff(s) in the above-

captioned matter hereby request that the Clerk of Court mark the within case as follows:

Dismissed With Prejudice Dismissed Without Prejudice As paid and satisfied Settled This day of , 20 . Plaintiff Plaintiff