Form 62a370a - Application For Certificate Of Registration To Purchase Certificates Of Delinquency Page 4
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4Affidavit
I,
, STATE UNDER PENALTY OF PERJURY THAT THE FOREGOING
INFORMATION SET FORTH IN THIS APPLICATION, INCLUDING INFORMATION PROVIDED IN THE
REQUIRED ATTACHMENTS HERETO, IS TRUE, CORRECT AND COMPLETE.
STATE OF
SIGNATURE OF INDIVIDUAL
CITY / COUNTY
TITLE
Personally appeared before me,
, who being duly
NAME OF INDIVIDUAL
Sworn according to law, deposes and says that the statements contained in this
application are true and correct.
Sworn and subscribed before me this
day of
, 20
.
____________________________________
NOTARY PUBLIC
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