Affidavit of Correctness (Of Account)

AFFIDAVIT OF CORRECTNESS Co-Signer, if applicable: 1. NAME: 2. SOCIAL SECURITY NO. (Last 4 Digits): 3. ADDRESS: 4. DATE OF NOTE: 5. ORIGINAL AMOUNT: 6. TERMS OF PAYMENT: 7. UNPAID BALANCE: 8. REBATED BALANCE: 9. DATE LAST PAID: 10. CONTRACT INTEREST RATE: 11. CONTRACTUAL MATURITY DATE: 12. INTEREST AFTER MATURITY: 13. SECURITY. (IF APPLICABLE): STATE OF LOUISIANA PARISH OF ___________________________ BEFORE ME, the undersigned authority, personally came and appeared: __________________________ Plaintiff Name Represented herein by __________________________, its duly authorized representative who deposed: Representative Name That he/she is personally familiar with the account at issue in this litigation. That all above information is true and correct and that the promissory note and/or security agreement attached hereto and made part of hereof are the instruments upon which this action is based. Signature: _______________________________________ Print Name/Title: _________________________________ SWORN TO AND SUBSCRIBED, before me this ______ day of ____________________, 20___. _______________________________________ NOTARY PUBLIC Notary/Print Name: _______________________________________ Notary No: ______________________________________________ My Commission Expires: __________________________________ Civil ­ Affidavit of Correctness (6-13-17) American LegalNet, Inc. www.FormsWorkFlow.com