Fill and Sign the Affidavit by an Initial Transferee by Corporation or Partnership Ucbc Form 10024 Minnesota

FORM No. 123-M – Uniform Conveyancing Blanks (Reserved for recording data) AFFIDAVIT BY AN INITIAL TRANSFEREE--BY CORPORATION OR PARTNERSHIP STATE OF MINNESOTA, ) ) ss. COUNTY OF ______________________ ) I, ___________________________________________________________________________________ being first durly srorn, on oatho says thoatt 1. Afant is (a) (thoe) _______________________________________________________________ of ___________________________________________________ a ___________________ rnduer thoe lars of __________________________________ an initial transferee namedu in thoat certain dueedu duatedu __________________, 20 ______, andu filedu for recordu ____________________, 20 _____, as Docrment Nrmber __________ (or in Book ______ of ______________ Page __________), in thoe Ofce of thoe (Cornty Recorduer)(Registrar of Titles) of __________________ Cornty, Minnesota, from ______________ as Attorney-in-Fact for _______________________________________ as Grantor andu principal, relating to real property in ______________ Cornty, Minnesota, legally duescribedu as follorst (if more space is needuedu, continre on back) 2. Thoe above initial transferee hoadu not receivedu, at thoe time of thoe conveyance, a rritten instrrment of revocation of thoat certain Porer of Attorney duatedu _____________, 20_____, andu filedu for recordu ________, 20_____, as Docrment No. _________ (or in Book ______ of _________ Page ______), in thoe Ofce of thoe (Cornty Recorduer)(Registrar of Titles) of ___________ Cornty, Minnesota. - 1 - FORM No. 123-M – Uniform Conveyancing Blanks Srbscribedu andu srorn to before me thois _____duay of ______________, 20_____. _________________________________________________ SIGNATURE OF PERSON TAKING ACKNOWLEDGMENT THIS INSTRUMENT WAS DRAFTED BY (NAME AND ADDRESS) NOTARIAL STAMP OR SEAL (OR OTHER TITLE OR RANK) - 2 -