Record and Return to: 1) EDIT WHAT IS IN BLUE TO FIT YOUR SITUATION.

First:Last 2) SELECT ALL THE TEXT, CHANGE COLOR TO BLACK.

c/o P O Box XXXXX 3) DELETE THIS TEXT, SAVE FILE, PRINT AS NEEDED.
City, Ohio; [zip in these brackets]

SPACE ABOVE FOR RECORDER USE

AFFIDAVIT AND NOTICE OF NON-ABANDONMENT

I, First:Last, a man in the flesh that the blood does flow and the air is breathed, as undersigned Affiant,
and as domicilee since about the date of the XXth day of Month, 19XX/20XX, do hereby declare that I
have not nor do I ever intend to abandon, voluntary or otherwise, the property located in _______
County in the state of Ohio as being the following described real property:

Situated in the City of __________, County of __________, Town ___, Range ___, being
sublot __ in _________ Realty Company ___________ Subdivision on part of Original
___________ Township Lot Number ___ as shown by the recorded plat in Volume ___ of
Maps, Page ___ of ____________ County Records and bounded and described as follows:

Parcel No. XX

Being a parcel of land lying on the north/south/west/easterly side of __________ Avenue/Street/

Lane and being located within the following described points in the boundary thereof:

Commencing at a monument found on the right-of-way centerline of ........find your legal

description's survey details on the deed and place it here.......to the true place of the beginning.

Parcel Number: XXX-XX-XXX

Physical Address: House Number Avenue/Street/Lane, City, Ohio; [zip code in these brackets]

I, the undersigned Affiant, do fully intent to permanently occupy the real property on a regular
basis both now and in the future and I do state and claim the above description of real property to be
my personal private property since the XXth day of Month, 19XX/20XX and permanent domicile until
further written notice is given and signed by the above named Affiant.

I, the undersigned Affiant, do hereby declare and file this Affidavit and Notice of Non-
Abandonment and sign below, as it being a true, correct and valid claim of my intent, under penalty of
perjury within the laws of the Constitution for the State of Ohio and the Constitution for the united
States of America.

___________________________________
First:Last

The above named, First:Last, personally known to me/by identification satisfactorily provided,
did appear before me and did execute this two-paged document foregoing on this day of
_____________, 2011.

Seal

______________________________
Notary Public