Fill and Sign the Affidavit Ownership Form

Affidavit as to Ownership of Certain Personal Property in a Country Other than the United States State of _________________________ County of _______________________ PERSONALLY appeared before me, the undersigned authority in and for said county and state, _________________________________ (name) , who, having been being first duty sworn by the undersigned Notary Public, deposes and says: 1. My name is ________________________________ (name) ; I am over the age of 21; and I presently reside at ________________________________________________ (street address and city) , ________________________ (state) , USA ____________ (zip code) . 2. From ___________________________ (date) until ________________________ (date) , I had the pleasure of residing in the _____________________________________ (city/state) of ________ ____________________________________ (country) . While residing in _____________________________________________ (city/state) , I was a _____________________________________ (occupation) from __________ (year) to __________ (year) at _________________________________________ (name of employer) . 3. While living and working in ________________________________________ (city/state) , my husband/wife __________________________________ (spouse’s name) and I made purchases of personal property from time to time from our own personal funds. Listed below are certain items which we purchased with our own personal funds, the present ownership of which is apparently now in dispute. Unless otherwise indicated, all of the property described below was located at ______________________________ ______________________________________________________________________ _______________ (address) when we left _____________________________________ (city/ state) in ____________ (year) . (EXAMPLES) A. Work Desk from one of the bedrooms. B. Three portable storage closets, two from the master bedroom and one from the guest bedroom. C. Two king sized beds with headboards. D. Certain clothing, sheets, blankets, pillows, pillowcases and comforters. E. Personal books. F. Double door refrigerator. G. Table-top Stove. H. Small microwave oven. I. Toaster Oven. J. Floor freezer. K. Two air conditioners. L. Generator (5KW gasoline). M. Stacked washer-dryer combination. N. Sofa-bed. O. Blue reclining chair. P. 20 HP Johnson Outboard motor Q. Two large TV sets (Standard- not HD) R. Home audio system S. DVD/ VHS player T. Library of VHS Tapes and DVD discs. U. Two floor (torch) lamps. V. Ten gallon water heater from residence. W. Coffee table. X. Entertainment Center. Y. Personal Hewlett Packard Printer. Z. Four Full Sized Floor Mattresses. AA. Pots, pans, dishes and silverware. All of the above can be identified by _____________________________ (name) and/or ____________________________________ (name) who formerly resided in ______________________________________________ (city/ state) . All rights, title and interest to each of these items were given by my husband/wife ____________________________ (spouse’s name) and I to _______________________ (name) and ___________________________ (name) in ____________ (year) . ________________________________ (Signature of Affiant) _________________________________ (Print or Type Name) SWORN to and subscribed before me, this the ____ day of _________________, 20____. __________________________ NOTARY PUBLIC My Commission Expires: ______________________