Fill and Sign the Financial Responsibility 497328490 Form

Affidavit of Financial Responsibility STATE OF ____________________ COUNTY OF _______________________ PERSONALLY appeared before me, the undersigned authority in and for said county and state , ___________________________ , who, having been being first duty sworn by the undersigned Notary Public, deposes and says: 1. My name is ___________________________ 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, year). 3. My net worth is approximately ___________________ Dollars ($_____________), exclusive of property exempt from execution, and over and above the amount of all my debts and liabilities. 4. I am the owner of real property located at ______________________________________ (street address, city, county, state) , the title to which is of record in my name in the office of ___________________________ (County Official = s office that keeps real property records) of ___________________________ (county, state). 5. The current fair market value of the real property described in Paragraph 4 above is ___________________ Dollars ($_____________), and such properly is subject to no encumbrances except ______________________________________________________ (e.g., mortgage held by Acme Mortgage Company securing a Promissory Note with a balance of $50,000.00). (Any Further Statement of Facts by Affiant) ___________________________ SWORN to and subscribed before me, this the ____ day of _____________, 20____. ______________________ NOTARY PUBLIC My Commission Expires: ____________________