Affidavit As To Judgments And/or Liens Form printable pdf download

AFFIDAVIT AS TO JUDGMENTS AND/OR LIENS

Commitment No.: ________________

Re Sale/Refinance of ________________________________________________________ (Property)

The undersigned, being first duly sworn, deposes and states that:

1. I am now or have been the owner of the property (“Property”) identified above and described in the above-referenced

commitment.

2. I have been informed that there are judgments and/or liens docketed or filed in the Office of the Register of Deeds

(“Register”) or in the courts of the County in which the Property is located (“County”) against persons whose names are

similar to my name, but that none of said judgments and/or liens shown below are against me.

3. I further state that there have been no proceedings in bankruptcy, divorce, change of name, insanity or incompetency and

that there are no unsatisfied judgments or liens docketed or filed against me in the Register's office or in any courts of the

County or in any United States District Court; and that there are no tax liens, State or Federal, filed against me.

4. During the last 10 years, I have resided at all of the following addresses in the County:

__________________________________________________________________________________

5. My Social Security No. is _________________________ (required only in connection with child support liens).

6. My date of birth is_________________________ (required only in connection with child support liens).

7. I understand that title company shown on the Commitment (“Agent”), as agent for the title insurance underwriter

named in the Commitment (“Underwriter”) (Agent and Underwriter are collectively, referred to as “Companies”),

shall rely upon these statements and representations to issue its title insurance policies on the above-referenced

commitment. I agree to indemnify the Companies against any loss or damage caused by inaccuracies and/or

omissions in the above information known to me and not disclosed by this affidavit, plus any cost, expense or

liability, including attorney fees, arising from the enforcement of this indemnification.

Dated: _________________________

Subscribed and sworn to before me this

____ day of

(year).

____________________________________

___________________________________

Notary Public

Print Name: __________________________

My commission (expires) (is permanent).

_________________________________ (SEAL)

List of Judgments and/or Liens to which this Affidavit Applies

Case No: ____________________________