Fill and Sign the Affidavit Regarding Form

Affidavit regarding Employee who embezzled the proceeds of an Endorsed Check Payable to the Employer of Employee. Affidavit of _______________________ (Name of Affiant) 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 the Affiant) and I am above the age of twenty-one (21) years of age a fully competent to make this Affidavit. 2. On ____________ (date) , the company of _____________________________ (Name of Construction Company) of _____________________________________ ( street address, city, state, zip code) , replace the damaged roof on my home at ___________________________________________ (street address, city, state, zip code) . Because of the nature of the cause of the damage to my roof, I filed a claim on my insurance company ________________________ (Name of Insurance Company) of _________________________________________ (street address, city, state, zip code) . 3. I received a check in the amount of $_____________ from said Insurance Company on ___________________ (date) . I endorsed the check and at the request of _________________________ (Name of Salesman who embezzled check) , who is a Salesman for _____________________________ (Name of Construction Company) . I deliver said check to ________________________ (Name of Salesman) . 4. When I delivered said endorsed check to __________________________ (Name of Salesman) , it was my understanding that the check or the proceeds from cashing the check would be turned over to __________________________________ (Name of Construction Company) as partial payment for replacing my roof. ___________________________________ (Printed Name of Affiant) ___________________________________ (Signature of Affiant) SWORN to and subscribed before me, this the ____ day of _____________, 20____. _____________________________ NOTARY PUBLIC My Commission Expires: ___________________