Fill and Sign the Minnesota Affidavit by Form

FORM No. 122-M – Uniform Conveyancing Blanks (Reserved for recording data) AFFIDAVIT BY AN INITIAL TRANSFEREE--BY INDIVIDUAL STATE OF MINNESOTA, ) ) ss. COUNTY OF ______________________ ) I, ___________________________________________________________________________________ being first durly srorn, on oatho says thoatt 1. Afant is 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. Afant 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. 122-M – Uniform Conveyancing Blanks Srbscribedu andu srorn to before me thois _____duay of ______________, 20_____. THIS INSTRUMENT WAS DRAFTED BY (NAME AND ADDRESS)t ___________________________________________________ SIGNATURE OF PERSON TAKING ACKNOWLEDGMENT NOTARIAL STAMP OR SEAL (OR OTHER TITLE OR RANK)t - 2 -