Louisiana > Local Parish > East Baton Rouge > District Court

Affidavit Of Distinction With Acknowledgment 37 - Louisiana

Affidavit Of Distinction With Acknowledgment Form. This is a Louisiana form and can be used in District Court East Baton Rouge Local Parish .
 Fillable pdf Last Modified 12/11/2013
Get this form for FREE as a print-only pdf

STATE OF LOUISIANA PARISH OF _______________________ AFFIDAVIT OF DISTINCTION (Pursuant to La. R.S. 9:5501.1) BEFORE ME, the undersigned authority ___________________________, personally came and appeared: __________________________, _________________________________________________, (affiant) (marital status and mailing address) who, after being duly sworn deposed as follows: I, _______________________________, being of sound mind acknowledge and (affiant's full name) understand that any intentional falsification of information I am about to provide shall subject me to penalties for the crime of injuring public records and false swearing. My full name is ____________________________________________________. I am ________________ years old and I was born on ______________________ (month/day/year) at _______________________________________________________________. (city,parish/county,state of birth) The last 4 digits of my social security number are __________________________. I presently reside at _________________________________________________. My previous addresses for the preceding 10 years were: ____________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________. The name and address of my employer is _______________________________ _________________________________________________________________. The name and address of location of employment is _______________________ _________________________________________________________________. My occupation is ___________________________________________________. My marital status is _________________________________________________. If married, my spouse's full name is ____________________________________. (including maiden name) The last 4 digits of my spouse's social security number are __________________. I HEREBY AFFIRM AND ATTEST, under penalty of law, that I am not the same person as the debtor or debtors named in the following described recorded judgments, liens, privileges or mortgages: Thus done, read and signed at______________________, Louisiana, this _____ day of ____________________, 20 _____. WITNESSES: _____________________________ (Signature) _____________________________ AFFIANT _____________________________ (Printed name of witness) _____________________________ (Signature) _____________________________ (Printed name of witness) __________________________________ Notary Public Printed Name: _________________________ Notary ID #: ___________________________ Mortgage Dept. Form #37 Rev. 6/28/2012 Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com ACKNOWLEDGMENT STATE OF LOUISIANA PARISH OF _______________________ I, (we) ________________________________________________________________, (Name of Judgment Creditor) hereby acknowledge that the above named affiant is not the same person identified or named in the above identified or described __________________________________________________ (judgment, lien, privilege, or mortgage) and that the property of the affiant is not subject to the judicial mortgage resulting from the judgment. Thus done, read and signed at __________________________, State of Louisiana, this _____ day of the month of ____________________, 20 _____. _____________________________________ Judgment Creditor Address: ______________________________ ______________________________________ ____________________________________ Notary Public Printed Name: ___________________________ Notary ID #: _____________________________ Page 2 of 2 Mortgage Dept. Form # 37 Rev. 6/28/2012 American LegalNet, Inc. www.FormsWorkFlow.com
Link/Embed this Document
URL
Embed


Popular Searches

  1. Preliminary Change of Ownership Report
  2. Decree of Dissolution of Marriage
  3. Notice and Acknowledgment of Receipt
  4. proof of service of summons
  5. Petition to Expunge
  6. writ of replevin
  7. fee waiver
  8. Income and Expense Declaration
  9. divorce forms
  10. proof of claim

Bookmark and Share