Affidavit of Financial Responsibility
STATE OF ____________________
COUNTY OF _______________________
PERSONALLY appeared before me, the undersigned authority in and for said
county and state, (Name of Affiant), who, having been being first duty sworn by the
undersigned Notary Public, deposes and says:
1. I, (name of affiant), am a resident of (street address, city, state, zip code).
2. My net worth is approximately $[dollar amount of net worth of premises],
exclusive of property exempt from execution, and over and above the amount of all my
debts and liabilities.
3. My property includes the premises known as [name of premises], located at [address
of premises], the title to which is of record in my name in the office of [name o