Affidavit of Payment History (State of: ____________________) SS:
(County of: ____________________)
BEFORE ME, the undersigned authority, duly authorized in the state and county aforesaid to take acknowledgements, this day personally appeared the undersigned Affiant(s), , jointly and severally if more than one (hereinafter referred to collectively as "Affiant"), who, first being duly sworn, depose(s) and say(s):
(1) Affiant is the holder of that certain Note and Deed of Trust, dated __________________ and recorded in Volume _______________ , Page(s) ____________________ , of the _________________ County records, State of _____________________________, encumbering property located at :
(2) Affiant has been personally responsible for the receiving of payments and servicing of said Note and Deed of Trust for the time period starting _________________ , thru __________________and including the date hereof.
(3) The following table represents a true and accurate accounting of the payment history for said Note and Deed of Trust:
Payment Due Date Amount$ Due Amount $Received Comments/Explanations
1. ______ ____ _____ ________
2. ______ ____ _____ ________
3. ______ ____ _____ ________
4. ______ ____ _____ ________
5. ______ ____ _____ ________
6. ______ ____ _____ ________
7. ______ ____ _____ ________
8. ______ ____ _____ ________
9. ______ ____ _____ ________
10. ______ ____ ____ _______
11. ______ ____ _____ ________
12. ______ ____ _____ ________
13. ______ ____ _____ ________
14. ______ ____ _____ ________
15. ______ ____ _____ ________
16. ______ ____ _____ ________
17. ______ ____ _____ ________
18. ______ ____ _____ ________
19. ______ ____ _____ ________
20. ______ ____ ____ _______
21. ______ ____ _____ ________
22. ______ ____ _____ ________
23. ______ ____ _____ _______
24. ______ ____ _____ ________
25. ______ ____ _____ ________
26. ______ ____ ______ ________
27. ______ ____ ______ ________
28. ______ ____ _____ ________
29. ______ ____ _____ ________
(4) There have been no returned checks, except as noted below:
Date Check Date Coments/
Originally Amont Ultimately Explanations
Received Cured
1. ______ ____ _____ ________
2. ______ ____ _____ ________
3. ______ ____ _____ ________
4. ______ ____ _____ ________
5. ______ ____ _____ ________
6. ______ ____ _____ ________
(5) I acknowledge that this information is being relied upon as an inducement for a Purchaser to acquire said Note and Deed of Trust. I swear under penalty of perjury that the above information is true, accurate, and complete and may be relied upon in all respects.
FURTHER, Affiant(s) sayeth naught.
Date:
_______________________ _______________________
Witness Beneficiary/Lender/Affiant
_______________________
Witness
_______________________ _______________________
Witness Beneficiary/Lender/Affiant
_______________________
Witness
Notary Public This document and accompanying materials are designed to provide authoritative information in regard to the subject matter covered in it. It is for illustration purposes only and presented with the understanding that the author and publisher are not engaged in rendering legal, accounting or other professional opinions. If legal advice or other expert assistance is required, the services of a competent professional should be sought. |
