Dbpr Form Abt-6022 - Examination Application (Page 2 of 2) in pdf

Dbpr Form Abt-6022 - Examination Application Page 2

SECTION 6 – SIGNATURE REQUIRED BY DEBTOR AND SECURED PARTY

NOTARIZATION REQUIRED

__________________________________________________________

Signature(s) of Debtor

__________________________________________________________

Print Name of Person(s) signing as Debtor

STATE OF___________________

COUNTY OF_________________

The foregoing was ( ) Sworn to and Subscribed OR ( ) Acknowledged Before me this _______Day

of______________, 20_____, By_____________________________________ who is ( ) personally known to

me OR ( ) who produced ______________________________________________as identification.

________________________________________________ Commission Expires: ___________________

Notary Public

__________________________________________________________

Signature of Secured Party

__________________________________________________________

Print Name of Person signing as Secured Party

STATE OF___________________

COUNTY OF_________________

The foregoing was ( ) Sworn to and Subscribed OR ( ) Acknowledged Before me this _______Day

of______________, 20_____, By_____________________________________ who is ( ) personally known to

me OR ( ) who produced ______________________________________________as identification.

________________________________________________ Commission Expires: ___________________

Notary Public

FOR DIVISION USE ONLY – DO NOT WRITE BELOW THIS LINE

Rejected

Date Stamp

Reason:

Accepted

Date_______ Initials_______________

Dbpr Form Abt-6022 - Examination Application Page 2