Fill and Sign the Affidavit of Financial Holdings or Net Worth Form

Affidavit of Financial Holdings or Net Worth STATE OF ____________________COUNTY OF _______________________PERSONALLY appeared before me, the undersigned authority in and for said county and state, __________________ (Name of Affiant), who, having been being first duty sworn by the undersigned Notary Public, deposes and says:1. My name is __________________ (Name of Affiant) and I am above the age of twenty-one (21) years.2. I reside at _______________________________________________________ _________________ (street address, city, county, state), and I have resided at said address since _______________ (Month and Year).3. My net worth is approximately $ ___________, exclusive of property exempt from execution, and over and above the amount of all my debts and liabilities.4.I am the owner of real property located at _______________________________ ______________________________________ (street address, city, county, state), the title to which is of record in my name in the office of _________________________ ______________ (Name of County Official’s office that keeps real property records) of _______________________________ (Name of County, State).5.The current fair market value of the real property described in Paragraph 4 aboveis approximately $______________, and such properly is subject to no encumbrances except a mortgage held by ____________________ (Name) Mortgage Company securing a Promissory Note with a balance of $_________________.________________________________ (Printed Name of Affiant) ________________________________ (Signature of Affiant)SWORN to and subscribed before me, this the ____ day of ________________, 20____._____________________________NOTARY PUBLICMy Commission Expires:___________________