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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.

South carolina manufactured ho... STATE OF SOUTH CAROLINA MANUFACTURED HOME AFFIDAVIT FOR RETIREMENT COUNTY OF OF TITLE CERTIFICATE 1 Name of Owner 2 Description of Manufactured Home Date of Manufacture Manufacturer Model year Make Width Length Identification Number VIN 3 Check whichever is applicable The above described manufactured home is not subject to a security lien. by law will be filed naming the secured parties. 4 Full legal description of new property to which manufactured home is to be affixed using metes and bounds or reference to recorded plat by book and page. A separate sheet identified as Exhibit A may be attached* 5 Derivation This being the identical or a portion of property conveyed or leased to the owner by deed or lease from and recorded in Book at page. Tax map number Tax billing address 6 The above described manufactured home is permanently affixed or is to be permanently affixed to the above described real property and the title certificate is to be retired in accordance with applicable law. 7 Check if applicable The owner of the manufactured home owns or has a leasehold estate of thirty-five or more years in the real property to which the manufactured home is affixed* 8 WARNING the execution and filing of this affidavit transfers ownership of the manufactured home to the lawful owner of the real property to which it is affixed* The owner certifies that the above information provided by the owner is true and correct to the best information and belief of the owner. Date Signature of owner Type or print name of owner Witness Before me the undersigned Notary Public personally appeared who being duly sworn deposed and said that s he saw sign seal and deliver the foregoing Affidavit and that s he together with witnessed the execution thereof* SWORN to before me this day of Notary Public for L*S* My Commission Expires. 4 Full legal description of new property to which manufactured home is to be affixed using metes and bounds or reference to recorded plat by book and page. A separate sheet identified as Exhibit A may be attached* 5 Derivation This being the identical or a portion of property conveyed or leased to the owner by deed or lease from and recorded in Book at page. A separate sheet identified as Exhibit A may be attached* 5 Derivation This being the identical or a portion of property conveyed or leased to the owner by deed or lease from and recorded in Book at page. Tax map number Tax billing address 6 The above described manufactured home is permanently affixed or is to be permanently affixed to the above described real property and the title certificate is to be retired in accordance with applicable law. Tax map number Tax billing address 6 The above described manufactured home is permanently affixed or is to be permanently affixed to the above described real property and the title certificate is to be retired in accordance with applicable law. 7 Check if applicable The owner of the manufactured home owns or has a leasehold estate of thirty-five or more years in the real property to which the manufactured home is affixed* 8 WARNING the execution and filing of this affidavit transfers ownership of the manufactured home to the lawful owner of the real property to which it is affixed* The owner certifies that the above information provided by the owner is true and correct to the best information and belief of the owner.

L 8 2018 2019 form Form L8 Affidavit for NonReal Estate Investments: Resident Decedents Use this form for release of: New Jersey bank accounts;Stock in New Jersey corporations;Brokerage accounts; andNew Jersey investment

Louisiana small estate affidav... R-3405 4/02 Form IETT-103 State of Louisiana Department of Revenue P. O. Box 201 Baton Rouge LA 70821-0201 Affidavit of Small Succession This is to be used only for estates that meet all the requirements in the declaration below. Estate of Marital status of decedent Married Single Widowed Address of decedent at time of death number and street city state ZIP Date of death Decedent s Social Security Number Designated parish of decedent Declaration Upon my/our oath I/we solemnly swear that the information on this form and the following statements are true and correct 1. R-3405 4/02 Form IETT-103 State of Louisiana Department of Revenue P. O. Box 201 Baton Rouge LA 70821-0201 Affidavit of Small Succession This is to be used only for estates that meet all the requirements in the declaration below. Estate of Marital status of decedent Married Single Widowed Address of decedent at time of death number and street city state ZIP Date of death Decedent s Social Security Number Designated parish of decedent Declaration Upon my/our oath I/we solemnly swear that the information on this form and the following statements are true and correct 1. The decedent died intestate i*e* no will 2. The value of the decedent s succession does not exceed 50 000 based on gross assets 3. The decedent s estate contains no immovable property i*e* real estate and Under the penalties of perjury I/we declare that this affidavit including any accompanying schedules and statements is to the best of my/our knowledge and belief a true correct and complete identification of the death circumstances and legal heirship of the named decedent. Enter name and address of heir. Name Address City State ZIP SSN Relation Signature If more than four please attach supplementary list. Name Address Telephone Signature A descriptive list or inventory and values of property owned by the decedent at date of death must accompany affidavit. An inheritance tax return Form IETT-100 must accompany this affidavit if the gross estate is 15 000 or more or if any taxes are due. This affidavit must be notarized before it is submitted to the Secretary of Revenue. For office use only. Do not write in this block. Sworn to and subscribed before me this day of Based upon the foregoing facts inheritance tax in the amount of is due and has been paid to the State of Louisiana* By Louisiana Department of Revenue Telephone 225 219-0067 Date / year. Notary Public For assistance with inheritance tax questions call the Inheritance Gift and Estate Transfer Taxes Section at 225 219-0067 TDD 225 219-2114 or write to Inheritance Gift and Estate Transfer Taxes Section The Department of Revenue retains the right of review under Article 2954 of the Code of Civil Procedure. Estate of Marital status of decedent Married Single Widowed Address of decedent at time of death number and street city state ZIP Date of death Decedent s Social Security Number Designated parish of decedent Declaration Upon my/our oath I/we solemnly swear that the information on this form and the following statements are true and correct 1. The decedent died intestate i*e* no will 2. The value of the decedent s succession does not exceed 50 000 based on gross assets 3.

Australia general form affidav... MAGISTRATES COURT OF WESTERN AUSTRALIA GENERAL FORM OF AFFIDAVIT CRIMINAL JURISDICTION Person making affidavit Court number Magistrates Court at Date filed I name Address Occupation MAKE OATH / AFFIRM AND SAY as follows if insufficient space attach further supporting documents Signature of Sworn/ affirmed At On date Before Registrar/Justice of the Peace or other authorised witness Each page is to be dated and signed by the person making the affidavit and the witness Filed by service Contact details Prosecutor or prosecutor s lawyer Applicant Accused or accused s lawyer Other As above Other Please specify Telephone Email Facsimile Lawyer s ref..

Form 14a affidavit ONTARIO Court File Number Name of court Court office address Form 14A Affidavit general dated. Applicant s Full legal name address for service street number municipality postal code telephone fax and e-mail address if any. Continued on next sheet FLR 14A September 1 2005 Fran ais au verso Num ro de dossier du greffe Nom du tribunal situ e au Adresse du greffe Formule 14A Affidavit formule g n rale dat du Requ rant e s Nom et pr nom officiels et adresse aux fins de signification num ro et rue municipalit code postal num ros de t l phone et de t l copieur et adresse lectronique le cas ch ant. Lawyer s name address street number municipality postal code telephone fax numbers and e-mail address if any. Respondent s My name is full legal name. I live in municipality province. and I swear/affirm that the following is true Set out the statements of fact in consecutively numbered paragraphs. Where possible each numbered paragraph should consist of one complete sentence and be limited to a particular statement of fact. If you learned a fact from someone else you must give that person s name and state that you believe that fact to be true. Nom et adresse de l avocat e num ro et rue municipalit code postal num ros de t l phone et de t l copieur et adresse lectronique le cas ch ant. Intim e s Je m appelle nom et pr nom officiels. J habite municipalit et province. et je d clare sous serment/j affirme solennellement que les renseignements suivants sont v ridiques num rez les d clarations de fait sous forme de paragraphes num rot s cons cutivement. Si possible chaque paragraphe devrait consister en une seule phrase et se limiter une d claration de fait particuli re. Si vous avez appris le fait d une autre personne vous devez donner son nom et indiquer que vous tenez ce fait pour v ridique. Suite la page suivante er English on reverse page 2 Put a line through any blank space left on this page. Sworn/Affirmed before me at. in province state or country date Commissioner for taking affidavits Type or print name below if signature is illegible. Signature This form is to be signed in front of a lawyer justice of the peace notary public or dat du. page 2 Tracez une ligne horizontale en travers de tout espace laiss en blanc sur la pr sente page. D clar sous serment/Affirm solennellement devant moi. en/ /au. province tat ou pays Commissaire aux affidavits Dactylographiez le nom ou crivez-le en caract res d imprimerie ci-dessous si la signature est illisible La pr sente formule doit tre sign e en pr sence d un avocat d un juge de paix d un notaire ou d un. Lawyer s name address street number municipality postal code telephone fax numbers and e-mail address if any. Respondent s My name is full legal name. I live in municipality province. and I swear/affirm that the following is true Set out the statements of fact in consecutively numbered paragraphs. Respondent s My name is full legal name. I live in municipality province. and I swear/affirm that the following is true Set out the statements of fact in consecutively numbered paragraphs. Where possible each numbered paragraph should consist of one complete sentence and be limited to a particular statement of fact.

Osap affidavit form AFFIDAVI T MARITAL STATUS - SINGLE / SOLE SUPPORT NEVER MARRIED IN THE MATTER OF Full Name of Student AND An application to the Ontario Student Assistance Program OSAP THIS AFFIDAVIT IS MADE FOR THE SOLE PURPOSE OF application to OSAP Ontario Student Assistance Program. My current marital status is SINGLE I have never been married* I am the biological custodial and sole-supporting parent of the following child ren NAME OF CHILD CHILD S DATE OF BIRTH The above child ren will be living with me on a FULL-TIME basis during my study period at the following address. I receive monthly child support payments in the amount of. I make this affidavit in support of an application for student financial aid and for no illegal or improper purpose. SWORN before me at the City of this day of 2011 Signature of Student Official stamp required Signature Commissioner for taking Affidavits Note This affidavit must be sworn before a Justice of the Peace Commissioner for Oaths or a lawyer. Protection of privacy The information gathered on this form is collected under the authority of the McMaster University Act 1976. The information is used for the academic administrative financial and statistical purposes of the University including but not limited to admissions registration and maintaining records awards and scholarships convocation provision of student services including access to information systems alumni relations and disclosure to or on behalf of the applicable McMaster student government. This information is protected and is being collected pursuant to section 39 2 and section 42 of the Freedom of Information and Protection of Privacy Act of Ontario RSO 1990. Questions regarding the collection or use of this personal information should be directed to the Director Student Financial Aid Scholarships Gilmour Hall 120 McMaster University. My current marital status is SINGLE I have never been married* I am the biological custodial and sole-supporting parent of the following child ren NAME OF CHILD CHILD S DATE OF BIRTH The above child ren will be living with me on a FULL-TIME basis during my study period at the following address. I receive monthly child support payments in the amount of. I make this affidavit in support of an application for student financial aid and for no illegal or improper purpose. I receive monthly child support payments in the amount of. I make this affidavit in support of an application for student financial aid and for no illegal or improper purpose. SWORN before me at the City of this day of 2011 Signature of Student Official stamp required Signature Commissioner for taking Affidavits Note This affidavit must be sworn before a Justice of the Peace Commissioner for Oaths or a lawyer. SWORN before me at the City of this day of 2011 Signature of Student Official stamp required Signature Commissioner for taking Affidavits Note This affidavit must be sworn before a Justice of the Peace Commissioner for Oaths or a lawyer. Protection of privacy The information gathered on this form is collected under the authority of the McMaster University Act 1976.

Form 36 divorce ONTARIO Court File Number Name of court at Form 36 Affidavit for Divorce Court office address Applicant s Full legal name address for service street number municipality postal code telephone fax numbers and e-mail address if any. Er FLR 36 1 septembre 2005 Suite la page suivante English on reverse page 2 The legal basis for the divorce is that the respondent and I have been separated for at least one year. FLR 36 September 1 2005 Continued on next sheet Fran ais au verso Num ro de dossier du greffe Nom du tribunal situ e au Formule 36 Affidavit de divorce Adresse du greffe Requ rant e s Nom et pr nom officiels et adresse aux fins de signification num ro et rue municipalit code postal num ros de t l phone et de t l copieur et adresse lectronique le cas ch ant. Respondent s My name is full legal name I live in municipality province and I swear/affirm that the following is true I am the applicant in this divorce case. There is no chance of a reconciliation between the respondent and me. All the information in the application in this case is correct except State any corrections or changes to the information in the application. Write NONE if there are no corrections or changes. The certificate or registration of my marriage to the respondent has been signed and sealed by the Registrar General of Ontario and has been filed with the application. is attached to this affidavit. Lawyer s name address street number municipality postal code telephone fax numbers and e-mail address if any. Respondent s My name is full legal name I live in municipality province and I swear/affirm that the following is true I am the applicant in this divorce case. There is no chance of a reconciliation between the respondent and me. All the information in the application in this case is correct except State any corrections or changes to the information in the application* Write NONE if there are no corrections or changes. The certificate or registration of my marriage to the respondent has been signed and sealed by the Registrar General of Ontario and has been filed with the application* is attached to this affidavit. It was issued at place of issue on date by name and title of person who issued certificate and the information in it about my marriage is correct. I have not been able to get a certificate or registration of my marriage. I was married to the respondent on date at place of marriage The marriage was performed by name and title who had the authority to perform marriages in that place. Nom et adresse de l avocat e num ro et rue municipalit code postal num ros de t l phone et de t l copieur et adresse lectronique le cas ch ant. Intim e s Je m appelle nom et pr nom officiels J habite municipalit et province et je d clare sous serment/j affirme solennellement que les renseignements suivants sont v ridiques Je suis le/la requ rant e dans cette cause de divorce. Il n existe aucune possibilit de r conciliation entre l intim e et moi-m me. Tous les renseignements contenus dans la requ te qui fait l objet de cette cause sont exacts l exception de ce qui suit Indiquez les corrections ou modifications apporter aux renseignements.

Georgia t 11 form T-11 (Rev.07-2005) Affidavit of Correction Date: TO WHOM IT MAY CONCERN: The strikeover on the assignment of the attached Manufacturer's Certificate of Origin or Certificate of Title for the following

Michigan pre affidavit form Michigan Department of Treasury 2368 (Rev. 04-09) Reset Form Principal Residence Exemption (PRE) Affidavit Issued under authority of Public Act 206 of 1893. Read the instructions page before completing

Request for modification and a... INCOME/EXPENSES FOR HOUSEHOLD'. REQUEST FOR MODIFICATION AND AFFIDAVIT (RMA) page 2 -COMPLETE ALL TH REE PAGES OF THIS FORM ...

Affidavit of assets and liabil... r 398(1), (2) Form P(R) 1 Affidavit of assets and liabilities Property (Relationships) Act 1976 In the Family Court at .......................................... ................................................

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