Claim Of Lien Form Page 2
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2AFFIDAVIT VERIFYING CLAIM
I, _______________________________ named in the annexed claim, make oath and say that the
claim is true (or the claim so far as it relates to me is true).
(Where the affidavit is made by an agent or assignee, a clause must be added to the following
effect)
I am the agent (or assignee) of the claimant and I have full knowledge of the facts set out in the
annexed claim.
Sworn before me at ___________________ )
in the ____________________, this _____ )
day of ____________________, 20_____.
)
_________________________________
)
(Signature of Claimant)
_________________________________ )
A Commissioner for Oaths, Notary Public
)
in and for the Northwest Territories.
)
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