IN RE: UPSET SALE TAX CLAIM BUREAU

OF BERKS COUNTY HELD

SEPTEMBER

SALE NO. Docket No.

COMMONWEALTH OF__________________ :

: ss

COUNTY OF ________________ :

AFFIDAVIT OF IDENTITY

BEFORE ME, the undersigned, ___________________________________ [Notary Name] did personally appear this ____day of _________________________, 20___, _______________________________________________________________________, known to me to be the person described herein and said person did present a drivers license, or other acceptable photograph identification, issued in the Commonwealth of Pennsylvania, a copy of which is attached, and who, being by me duly sworn, deposes and says that:

A. He/she is the one and same person as named in this Affidavit.

B. That the purpose of this Affidavit is to establish and verify that the identity of the person described herein is the same as the individual named in the Petition of the Berks County Tax Claim Bureau for Distribution of Proceeds from a Tax Sale for the property located at ______________________________________________________________________________.

C. That the person named in this Affidavit understands that falsification in any degree of this Affidavit is a felony criminal offense and will subject such Affiant to prosecution to the fullest extent of the law.

___________________________________

IN WITNESS WHEREOF, I have hereunto set my hand and official seal.

__________________________

Notary Public