Affidavit Regarding Business Entity {50.1.3}

(Top 3 inches reserved for recording data) AFFIDAVIT REGARDING BUSINESS ENTITY Minnesota Uniform Conveyancing Blanks Form 50.1.3 (2011) State of Minnesota, County of being first duly sworn on oath say(s) that: (insert name of affiant) 1. (They are) ( he is) the respectively, of and the , , in the document as Document Number (month/day/year) a (the "Business Entity"), named as dated (month/day/year) under the laws of and filed for record , Page County, Minnesota. (or in Book of of ), in the Office of the County Recorder Registrar of Titles (check the applicable boxes) 2. The Business Entity's principal place of business is at and the Business Entity's principal place(s) of business during the last ten (10) years has/have been at: 3. There have been no: a. Bankruptcy or dissolution proceedings involving the Business Entity during the time period in which the Business Entity has had any interest in the premises described in the above document (" Premises"); b. Unsatisfied judgments of record against the Business Entity nor any actions pending in any courts, which affect the Premises; c. Tax liens filed against the Business Entity; except as herein stated: Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2 Minnesota Uniform Conveyancing Blanks Form 50.1.3 4. Any bankruptcy or dissolution proceedings of record against business entities with the same or similar names during the time period in which the Business Entity had any interest in the Premises are not against the Business Entity. 5. Any judgments or tax liens of record against entities with the same or similar names are not against the Business Entity. 6. There has been no labor or materials furnished to the Premises for which payment has not been made. 7. There are no unrecorded contracts, leases, easements, or other agreements or interests relating to the Premises except as stated herein: 8. There are no persons in possession of any portion of the Premises other than pursuant to a recorded document except as stated herein: 9. There are no encroachments or boundary line questions affecting the Premises of which Affiant(s) (has)(have) knowledge. Affiant(s) know(s) the matters herein stated are true and make(s) this Affidavit for the purpose of inducing the passing of title to the Premises. Affiant(s) (signature) (signature) Signed and sworn to before me on (month/day/year) , by (insert name of person making statement) . (Stamp) (signature of notarial officer) Title (and Rank): My commission expires: (month/day/year) THIS INSTRUMENT WAS DRAFTED BY: (insert name and address) American LegalNet, Inc. www.FormsWorkFlow.com