JUDGMENT, BANKRUPTCY AND TAX LIEN AFFIDAVIT

STATE OF ALABAMA

______COUNTY

Before me, the undersigned, personally appeared:

______

Who, after first being duly sworn, deposed and says the following:

My name is ______

I am over the age of 21 years, and a citizen of ______County, Alabama. I am the present titleholder of the following described property:

After entering into the aforesaid contract, The Title Group, Incorporated issued a title insurance binder requiring proof that I am not the same person against whom judgments, bankruptcies and/or tax liens are of record as shown in said title binder.

I have always been known as ______

and have never been known by any other name. I do not have any unpaid obligations except current bills, neither have I received any notice of any suit or judgments having been filed against me. I am definitely not the same person against whom said judgments and/or tax liens are of record, and specifically the following:

There are no judgments, nor tax liens outstanding against me. I have not filed for bankruptcy.

This affidavit is given to induce any purchaser to purchase, any lender to accept a mortgage on the Property and to induceTitle Company and Stewart Title Guaranty Company(hereafter described as “Title Insurance Company”)to issue its title insurance policy or policies in reliance upon any of the statements contained herein, and should the Title Insurance Company, in its sole discretion, issue insurance in reliance upon such representations, affiant agrees to indemnify and holdTitle Insurance Company harmless of and from any and all loss, cost, damage and expense of every kind, including attorneys’ fees, which Title Insurance Companyshall or may suffer or incur or become liable for under its said policy or policies now to be issued, or any reissue, renewal or extension thereof, directly or indirectly, as a result of any misrepresentation herewith.

______

Affiant

State of Alabama

______County

Sworn to and subscribed before me, this the

______day of ______, 20__,

______

Notary Public