) s.s.:

COUNTY OF -----------)

1. Introduction. [name], being duly sworn, deposes and says:

2. Description of Deponent. I am the [title] of [name], a corporation organized and existing under the laws of [state] (and qualified to do business under the laws of [state]), with its rincipal offices at [address]. I make this affidavit solely as an agent of [name] and in no other capacity.

3. Description of Property--Statement of Ownership. The corporation is the sole owner of the goods and chattels described in the annexed bill of sale [omitted] dated [date], and has full right and power to sell and transfer them.

4. No Mortgages or Liens. There are no mortgages, liens, security interests, or other encumbrances affecting the goods or chattels except [list of encumbrances].

5. Corporation's Debts. The corporation has no debts that affect the goods and chattels.

6. No Suits, Judgments, Bankruptcy or Insolvency Proceedings. No actions or proceedings in which the corporation is a defendant or respondent or that would affect the goods and chattels are pending in any court or other forum. There are no judgments, executions, attachments, or replevins outstanding against the corporation. No petition in bankruptcy or petition for an arrangement with creditors has been filed by or against the corporation. The corporation has not availed itself of relief under any law relating to insolvency.

7. Inducement to Buyer. This affidavit is made for the specific purpose of inducing [name] to purchase the goods and chattels described in the annexed bill of sale. I am aware that [name], in making the purchase, will rely upon this affidavit.

Sworn to before me [signature]

[dated] Deponent

[signature]

Notary Public