Affidavit Of Distinction With Acknowledgment {37}

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