State of [State]
County of [County]
Before me, a duly commissioned Notary Public within and for
the State and County aforesaid, personally appeared [full legal name]
who, after being duly sworn as required by law,
deposes and says:
1. That (s)he is the [title] of [firm].
2.That [said firm] is the owner of the
improved property known and legally described as follows:
SEE EXHIBIT "A" ATTACHED HERETO
or
[set forth legal description]
3. That [full legal name] is not the subject to any
bankruptcy, creditor's reorganization or insolvency
proceeding and none are pending, contemplated or threatened.
4. That [full legal name] has possession of the
property and that there is no other person in possession
who has any right in the property.
5. That there are no unrecorded labor, mechanic's or
materialmen's liens against the property and no material
has been furnished or labor performed on the property which
has not been paid in full.
6. That there are no unrecorded easements, liens of
assessments for sanitary sewers, paving or other public
utilities against said property.
7. That there are no claims whatsoever of any kind or
description against any fixtures or equipment located on
the said premises.
8. That there are no existing contracts for sale, options
to purchase or unrecorded deeds or mortgages existing
against said property.
9. That this affidavit is made for the purpose of [Describe
as much as possible in full detail].
______________________________________________
[clearly print name after signature]
Subscribed and sworn to before me this [numerical] day of
[Month], [Year].
Notary Public: __________________________________
[clearly print name after signature]
My commission expires:
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