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Caregiver authorization affida... CAREGIVER AUTHORIZATION AFFIDAVIT Massachusetts General Laws Chapter 201F 1. AUTHORIZING PARTY (Parent/Guardian) I, , residing at am: (circle one) the parent legal guardian legal custodian of the

Junk affidavit missouri form SHP-498A 05/12 MISSOURI STATE HIGHWAY PATROL JUNK SALVAGE OR REBUILDING AFFIDAVIT Year Make Mileage Model Vehicle Identification Number Name of Seller I understand the vehicle listed above which I am buying from the seller has not been inspected and is in an unsafe mechanical condition. The vehicle is being purchased for junk salvage or rebuilding.

Montana financial affidavit fo... Print Reset this will clear all form fields MONTANA CHILD SUPPORT GUIDELINES FINANCIAL AFFIDAVIT INSTRUCTIONS FOR COMPLETING THIS FORM Provide complete information attaching additional pages if needed. If a question or statement does not apply to you DO NOT LEAVE IT BLANK instead mark it as Not Applicable or N/A. Be sure to sign this form and have your signature notarized* A. PERSONAL INFORMATION Full Name Work Phone No* Home Address Home/Cell No* Date of Birth Case Number Mailing Address Driver s License No* What is your tax filing status Single Married joint Married separate Head of Household List the people you claim as tax exemptions If you are married and file taxes jointly please provide your current spouse s annual income so that tax credits may be calculated accurately. Did you finish high school Yes No If no indicate highest grade completed List all schools attended following high school* Include training school college or university trade school* School Name Course of Study Completion Date Degree/Diploma B. CHILDREN 1. List all of your natural and adopted children do not include stepchildren Child s Full Name Month/Day/Year Who does child live with Are you ordered to pay support for this child amount/month ATTACH A COPY OF ANY ORDER REQUIRING CHILD SUPPORT TO BE PAID FOR THESE CHILDREN* CS404. 6A Rev*8/10 2. Complete the table below for all expenses you pay and benefits you receive on behalf of all children shown in the previous table. Attach proof for the items listed below. Do NOT list amounts paid by other parent. Child s First Name Annual Day Care Costs Unreimbursed Medical Expenses How many days does child spend with you per year Dependent s Benefits Received Miles Driven for Long Distance Parenting Other Transportation Costs for Long For example - Social Security Benefits The majority of a 24 hour period the children are in your control Do not include lodging food and entertainment 3. Do you receive reimbursement for day care expenses /month reimbursement If any of the children listed above have ongoing medical expenses please describe. 5. Do you have health insurance available to you through employment or other group If no skip to Section C. If yes to have the cost included in your child support calculation you must do one of the following before the final order is entered A. Prove that you currently have insurance coverage in effect for the children or B. Obtain verification from the insurance carrier that you have paid a premium with the intent to enroll the children* Name everyone who is covered by this policy Regardless of whether your children are covered complete the following Insurance Co. Name Address Policy Number Certificate Number Total cost of health insurance premium per month including your children whether or not you and the children are currently enrolled. Adult s portion of premium* Child ren s portion of premium* Portion of premium to be paid by you each month. C. EMPLOYMENT List your current or most recent employer s first and your past two employers Employer s Name Address and Telephone Number Dates of Employment Average Hours Worked and Current or Ending Pay From hours/week To pay/hour P-Permanent T-Temporary S-Seasonal What kinds of work do you/did you do for your employer s Do you belong to a union If yes name of union local address and amount of monthly dues 4.

Tennessee affidavit of transfe... TENNESSEE DEPARTMENT OF REVENUE AUDIT DIVISION P. O. BOX 190644 NASHVILLE TN 37219 AFFIDAVIT OF TRANSFER OF AIRCRAFT/HELICOPTER Pursuant to TCA 42-1-113 any person or dealer who sells an aircraft in this state any purchaser who purchases an aircraft in this state and every resident of this state who purchases an aircraft shall report to the Department of Revenue the following information. MARK ALL THAT APPLY New Used Non-resident purchaser Comple...

Mn small estate affidavit form AFFIDAVIT FOR COLLECTION OF PERSONAL PROPERTY Minnesota Statutes 524.3-1201 Estate of: , Decedent. I, state that: 1. My name is: . 2. My address is: . 3. Decedent died on . A certified copy of Decedent's

Nv affidavit form 555 Wright Way Carson City NV 89711 Reno/Sparks/Carson City 775 684-4DMV 4368 Las Vegas area 702 486-4DMV 4368 Rural Nevada or Out of State 877 368-7828 www. dmvnv.com ERASURE AFFIDAVIT NRS 482. 245 An individual taking full responsibility for an error change or removal of information on ownership documents must complete and sign the Erasure Affidavit. 555 Wright Way Carson City NV 89711 Reno/Sparks/Carson City 775 684-4DMV 4368 Las Vegas area 702 486-4DMV 4368 Rural Nevada or Out of State 877 368-7828 www. dmvnv*com ERASURE AFFIDAVIT NRS 482. 245 An individual taking full responsibility for an error change or removal of information on ownership documents must complete and sign the Erasure Affidavit. If a person is being removed from the ownership documents that individual is required to sign the affidavit. When representing a business the business name and the name of the authorized business representative must appear on the affidavit. Please print or type Year Make Model Vehicle Identification Number The undersigned being duly sworn states that the error or change appearing on the attached Please describe what and where error is. I declare under penalty of perjury that the foregoing is true and correct. Affiant s Printed Full Legal Name Nevada Driver s License Identification Card Number Date of Birth or FEIN for Businesses Physical Address City State Zip Code Mailing Address State of Nevada County of Signed and sworn to before me on Date Signature of Affiant Notary Stamp Notary Public or Authorized Nevada DMV Representative VP-019 01/2014 Signatures must be originals. Photocopies are not acceptable. Changes may not be made to this form once it is signed and witnessed*. dmvnv*com ERASURE AFFIDAVIT NRS 482. 245 An individual taking full responsibility for an error change or removal of information on ownership documents must complete and sign the Erasure Affidavit. If a person is being removed from the ownership documents that individual is required to sign the affidavit. If a person is being removed from the ownership documents that individual is required to sign the affidavit. When representing a business the business name and the name of the authorized business representative must appear on the affidavit. When representing a business the business name and the name of the authorized business representative must appear on the affidavit. Please print or type Year Make Model Vehicle Identification Number The undersigned being duly sworn states that the error or change appearing on the attached Please describe what and where error is. Please print or type Year Make Model Vehicle Identification Number The undersigned being duly sworn states that the error or change appearing on the attached Please describe what and where error is. I declare under penalty of perjury that the foregoing is true and correct. Affiant s Printed Full Legal Name Nevada Driver s License Identification Card Number Date of Birth or FEIN for Businesses Physical Address City State Zip Code Mailing Address State of Nevada County of Signed and sworn to before me on Date Signature of Affiant Notary Stamp Notary Public or Authorized Nevada DMV Representative VP-019 01/2014 Signatures must be originals.

Affidavit of identity form 159... Date. Name of Person(s) . Signature of notarial officer. My commission expires: Month, Day, Year. Notary Stamp as. Type of Authority, e.g. Officer, Trustee, etc. of

Nv division of mineralsaffidav... The following Document contains no Personal Information as defined by NRS 603A.040 CERTIFICATE OF LOCATION LODE MINING CLAIM TO ALL WHOM IT MAY CONCERN: The locator hereby certifies that he has caused

Nv division of mineralsaffidav... The following Document contains no Personal Information as defined by NRS 603A.040 AFFIDAVIT OF ANNUAL ASSESSMENT WORK (Long Form) TO ALL WHOM IT MAY CONCERN: The undersigned, , certifies that at

Georgia domestic relations fin... IN THE SUPERIOR COURT OF STATE OF GEORGIA Plaintiff v. Defendant. Civil Action File Number DOMESTIC RELATIONS FINANCIAL AFFIDAVIT Affiant s Name Affiant s Age Spouse s Name Spouse s Age Names and birth dates of children for whom support is to be determined in this action NAME OF CHILD DATE OF BIRTH RESIDES WITH SUMMARY OF AFFIANT S INCOME AND NEEDS a Gross Monthly Income from item 3A b Net Monthly Income from item 3B c Average Monthly Expenses item 5A Monthly Payments to Creditors item 5B Total Monthly Expenses and Payments to creditors item 5C 3. A. AFFIANT S GROSS MONTHLY INCOME complete this section or attach Child Support Schedule A All income must be entered based on monthly average regardless of date of receipt. Salary or Wages ATTACH COPIES OF 2 MOST RECENT WAGE STATEMENTS Commissions Fees Tips Income from self-employment partnership close corporations and independent contracts gross receipts minus ordinary and necessary expenses required to produce income ATTACH SHEET ITEMIZING YOUR CALCULATIONS Rental Income gross receipts minus ordinary and necessary expenses required to produce income ATTACH SHEET ITEMIZING Bonuses Overtime Payments Severance Pay Recurring Income from Pensions or Retirement Plans Interest and Dividends Trust Income Income from Annuities Capital Gains Social Security Disability or Retirement Benefits Workers Compensation Benefits Unemployment Benefits Judgments from Personal Injury or Other Civil Cases Gifts cash or other gifts that can be converted to cash Prizes/Lottery Winnings Alimony and maintenance from persons not in this case Assets which are used for support of family Fringe Benefits if significantly reduce living expenses Any other income do NOT include meanstested Public assistance such as TANF or food stamps GROSS MONTHLY INCOME B. Affiant s Net Monthly Income from employment deducting only state and federal taxes and FICA Affiant s pay period i*e* weekly monthly etc* Number of exemptions claimed ASSETS If you claim or agree that all or part of an asset is non-marital indicate the non-marital portion under the appropriate spouse s column and state the amount and the basis premarital gift inheritance source of funds etc* DESCRIPTION VALUE Cash Stocks bonds CD s/Money Market Accounts Bank Accounts list each account Retirement Pensions 401K IRA or Profit Sharing Money owed you Tax Refund owed you Real Estate Home Debt Owed Other Automobiles/ Vehicles SEPARATE ASSET OF THE HUSBAND WIFE BASIS OF THE CLAIM Life Insurance net cash value Furniture/ Furnishings Jewelry Collectibles Other Assets TOTAL ASSETS 5. A. AVERAGE MONTHLY EXPENSES HOUSEHOLD Mortgage or rent payments Property taxes Homeowner/Renter Insurance Electricity Water Garbage and Sewer Telephone Residential line Cellular telephone Gas Repairs and maintenance Lawn Care Pest Control Cable TV Misc* household and grocery items Meals outside the home AUTOMOBILES Gasoline and oil Repairs Auto tags and license OTHER VEHICLES boats trailers RV s etc* Tags and license CHILDREN S EXPENSES Child care total monthly cost School tuition Tutoring Private lessons e*g* music dance School supplies/expenses Lunch Money Other Educational Expenses list Allowance Clothing Diapers Medical dental prescription out of pocket/uncovered expenses Grooming hygiene Gifts from children to others Entertainment Activities including extra-curricular school religious cultural etc* Summer Camps OTHER INSURANCE Health Child ren s portion Dental Vision Life Relationship of beneficiary Disability Other specify AFFIANT S OTHER EXPENSES Dry cleaning/laundry Affiant s gifts special holidays Recreational Expenses e*g* fitness Vacations Travel Expenses for Visitation Publications Dues clubs Religious and charities Alimony paid to former spouse Child support paid for other children Date of initial Order Other attach sheet TOTAL ABOVE EXPENSES PAYMENTS TO CREDITORS Please check one To Whom Balance Due Monthly Payment Joint TOTAL MONTHLY PAYMENTS TO CREDITORS C.

Affirmation of repossession 20... New York State Department of Motor Vehicles AFFIRMATION OF REPOSSESSION AND BILL OF SALE L E N D E R Business Name Number and Street Address City State ZIP Code B O R R O W E R Last Name, First, M.I.

Mvd 10059 form State of New Mexico - Motor Vehicle Division MVD - 10059 REV. 12/00 AFFIDAVIT OF RESALE Pursuant to Mechanic s or Landowner s Lien Requirements Lien Claimant affirms that the registered owner of the vehicle described below was justly indebted for services rendered as detailed in the Notice of Lien Form 10058 and that all interested parties including Lienholder if applicable were notified by registered mail of the amount due. Copies of notices of lien and registered mail return receipts must be attached* REGISTERED OWNER NAME ADDRESS CITY STATE ZIP CODE VEHICLE INFORMATION YEAR MAKE ENGINE NO. IF APPLICABLE MODEL VEHICLE ID NUMBER TYPE STATE REGISTERED LICENSE PLATE NO. THE VEHICLE WAS ADVERTISED FOR SALE AT PUBLIC AUCTION BY q Advertising two 2 consecutive weeks in a newspaper of general circulation in the county where the auction was held. Affidavit of publication and copy of advertisement attached* Posting six 6 notices handbills in six 6 conspicuous public locations in the county where the auction was held. Copy of notice / handbill attached* Notice of 1 Address PUBLIC AUCTION INFORMATION q AM Public auction was held by Lien Claimant on 20 at q PM in the County of and specifically at CITY STATE ZIP CODE The highest or only acceptable bid received was for the exact sum of and the vehicle was sold to Purchaser s Name Address City State Zip Code CAUTION If the exact sum of the bid exceeded the total indebtedness the Lien Claimant must refund the excess amount to the Registered Owner against whom the lien was claimed* - continued on back - No person appeared to bid or submit any acceptable offer to purchase the vehicle and after waiting fifteen 15 minutes after the specified hour of the auction the Lien Claimant bid on the vehicle for the amount of the lien in the exact sum of. NOTE PURCHASER OR LIEN CLAIMANT WHEN APPLICABLE MUST APPLY FOR TITLE IN HIS / HER NAME AND PAY THE REGISTRATION AND TITLE FEES* PURCHASER MUST ALSO PAY EXCISE TAX. ODOMETER MILEAGE STATEMENT FEDERAL AND STATE LAW REQUIRES THE TRANSFEROR SELLER OF A VEHICLE TO STATE THE ODOMETER MILEAGE UPON TRANSFER OF OWNERSHIP. ANYONE CONVICTED OF A FRAUDULENT ODOMETER STATEMENT WILL BE SUBJECT TO FINES AND / OR IMPRISONMENT. NOTE THE DIVISION IS NOT RESPONSIBLE FOR FALSE OR FRAUDULENT ODOMETER STATEMENTS MADE IN CONNECTION WITH TRANSFER OF OWNERSHIP OR HELD LIABLE FOR RECORDING ERRORS* I Lien Claimant hereby certify that the ODOMETER READING of the vehicle described above is no tenths miles and that to the best of my knowledge stated mileage is check one of the following THE ACTUAL MILEAGE AM Mileage Codes MILEAGE IN EXCESS OF MECHANICAL LIMITS EL WARNING NOT THE ACTUAL MILEAGE ODOMETER DISCREPANCY NM CERTIFICATION I hereby certify that all information given in this affidavit is true and correct to the best of my knowledge. Signature of Lien Claimant or Authorized Agent Date Printed Name PURCHASER S ACKNOWLEDGEMENT Signature of Purchaser or Authorized Agent NOTE IF PROPERLY COMPLETED AND ACCOMPANYING DOCUMENTS ARE CORRECT AND IN ORDER THIS AFFIDAVIT OF RESALE WILL SERVE AS AN ASSIGNMENT DOCUMENT AND A SEPARATE BILL OF SALE WILL NOT BE REQUIRED.

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