Fill and Sign the Verification of an Account 497329785 Form

Verification of an Account STATE OF _______________________________________ COUNTY OF ___________________________________ PERSONALLY appeared before me, the undersigned authority in and for said county and state, _____________________________________________________ (Name of Creditor) , who, having been being first duty sworn by the undersigned Notary Public, deposes and says: 1. The attached account signed by ________________________________________ (Name of Creditor) on _____________________________________________ (date of account) , and consisting of ___________ (number) pages is a correct and true copy from the books of original entry of ________________________________________________ (Name of Creditor) . 2. The charges entered in the account were made in the original books of ______________________________________________ (Name of Creditor) at or about the time the charges were made. 3. The goods for which the charges were made were sold and delivered to _______________________________________________ (Name of Debtor) as charged in the account. 4. The charges and the sum of such charges are correct and the account is correctly stated. 5. There is now due and owing to ________________________________________ (Name of Creditor) by ________________________________________________ (Name of Debtor) the sum of $___________________. 6. No part of the sum stated above has been paid or settled in any manner. 7. No deductions or offsets of any kind have been made by affiant, except those specified, credited and taken into consideration in the sum stated in the account. ____________________________________ (Printed Name of Creditor) ____________________________________ (Signature of Creditor) SWORN to and subscribed before me, this the _____ day of _______________________________________, 20_____. ____________________________________ NOTARY PUBLIC My Commission Expires: _______________________