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) )
) ) SS
COUNTY OF MARION
) ) )
STATE OF INDIANA
This Declaration constitutes notice and Secured Party Affidavit of Identity. Until and unless this Affidavit is rebutted by counter-affidavit, point-for-point or should any single point of this Affidavit be successfully rebutted, all remaining points not similarly rebutted it stands as truth in commercial law. So affirmed and humbly declared, before the goodness of the Creator. Without prejudice and all rights reserved.
Signed: ______________________________________________, Beneficiary Secured Party, of the Legal person, legal Entity and or Trust known by or rendered as JOHN H DOE.
State of INDIANA
MARION County
) ) ss. ) JURAT
On the ___ day of ________, 2012__, John Henry Doe; personally appeared before me and proved to me on the basis of satisfactory evidence to be the person whose name is subscribed hereto and acknowledged to me that he/she executed the same under oath or asseveration, and accepts the facts thereof. Subscribed and affirmed before me this day. Witness my hand and seal this _____ day of ____, 2012.
Notary Signature
SEAL