Waiver in form of affidavit.
Before me, the undersigned authority, a notary public in and for this county and state, personally appeared
and wife, , who, after being duly sworn on oath by me, did each depose and say:
Our names are and . We are husband and wife, and as such reside together in County,
. We are the owners of:
Lot , block of addition to the City of , County, , known as lot
numbered drive in , , upon which property we now reside, and which we now own,
occupy, use and claim as our homestead property or place of actual residence.
We further state that we are also the owners of:
Lot and the west of lot , block of addition to the City of , in
We here now state that we do not reside, occupy, use or claim the last above-described property as our homestead
property. We further state that we have removed from it all our furniture, household goods and personal effects of
whatever description; and that we now have and hold no manner of homestead claim against the last above-described
We make this affidavit as an inducement to company of , a corporation, to extend to us a loan upon the
security of the lot and the west of lot , in block , addition upon the security of
our two certain deeds of trust of this date to , trustee, recorded in the deeds of trust of this date to , trustee,
recorded in the deed of trust records of County, .
Executed this , 20 .
electronic form 2005