Verification of Account


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									This is a sworn statement made before a notary public verifying the accuracy of a
creditor's account. Verification of an account may be necessary in legal proceedings
and may be required by a court order. This statement verifies that the affiant, the
person making the statement, is providing an accurate and true copy of a creditor’s
account. The charges of the account must be found in the creditor’s original books at
the time the affiant incurred the charges. This statement can be used by individuals or
attorneys that need to verify the accuracy of an account.
                              Verification of an Account

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.     The attached Account signed by (Name of Creditor) on (date) and consisting of
(number) pages, is a correct and true copy from the books of original entry of the
Creditor, (Name of Creditor), and on which is charged to Affiant as Debtor, (Name of
Debtor), for the items indicated in the Account.

2.    The charges entered in the Account after the items indicated there were made in
the Creditor's original books at or about the time the Affiant incurred the charges.

3.     The goods for which the charges were made were sold and delivered as charged
in the Account.

4.     The charges and the sum of such charges are correct and the Account is
correctly stated.

5.    There is now due and owing the Creditor by the Debtor $______________.

6.    No part of the sum stated above has been paid or settled in any manner.

7.     There are no deductions or offsets by Affiant of any kind, except those specified,
credited and taken into consideration in the sum stated in the Account.

                                                (Printed Name of Affiant)
                                                (Signature of Affiant)

     SWORN to and subscribed before me, this the ____ day of _____________,

                                         NOTARY PUBLIC

My Commission Expires:

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