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AFFIDAVIT OF PAYMENT HISTORY

(State of: ____________________) SS:

(County of: ____________________)

 

BEFORE ME, the undersigned authority, duly authorized in the state and county aforesaid to take acknowledgements, this day personally appeared the undersigned Affiant(s), , jointly and severally if more than one (hereinafter referred to collectively as "Affiant"), who, first being duly sworn, depose(s) and say(s):

(1) Affiant is the holder of that certain Note and Deed of Trust, dated , 19 , and recorded in Volume , Page(s) , of the County records, State of , encumbering property located at .

 

(2) Affiant has been personally responsible for the receiving of payments and servicing of said Note and Deed of Trust for the time period starting , 19 , thru and including the date hereof.

(3) The following table represents a true and accurate accounting of the payment history for said Note and Deed of Trust:

Payment
Due Date
Amount
$ Due 
Amount
$Received
Comments/
Explanations
1. ______ ____ _____ ________
2. ______ ____ _____ ________
3. ______ ____ _____ ________
4. ______ ____ _____ ________
5. ______ ____ _____ ________
6. ______ ____ _____ ________
7. ______ ____ _____ ________
8. ______ ____ _____ ________
9. ______ ____ _____ ________
10. ______ ____ ____ _______
11. ______ ____ _____ ________
12. ______ ____ _____ ________
13. ______ ____ _____ ________
14. ______ ____ _____ ________
15. ______ ____ _____ ________
16. ______ ____ _____ ________
17. ______ ____ _____ ________
18. ______ ____ _____ ________
19. ______ ____ _____ ________
20. ______ ____ ____ _______
21. ______ ____ _____ ________
22. ______ ____ _____ ________
23. ______ ____ _____ ________
24. ______ ____ _____ ________
25. ______ ____ _____ ________
26. ______ ____ _____ ________
27. ______ ____ _____ ________
28. ______ ____ _____ ________
29. ______ ____ _____ ________

(4) There have been no returned checks, except as noted below:

Date
Originally
Received
Check
Amount
Date
Ultimately
Cured
Comments/
Explanations
1. ______ ____ _____ ________
2. ______ ____ _____ ________
3. ______ ____ _____ ________
4. ______ ____ _____ ________
5. ______ ____ _____ ________
6. ______ ____ _____ ________
7. ______ ____ _____ ________
8. ______ ____ _____ ________
9. ______ ____ _____ ________

(5) I acknowledge that this information is being relied upon as an inducement for a Purchaser to acquire said Note and Deed of Trust. I swear under penalty of perjury that the above information is true, accurate, and complete and may be relied upon in all respects.

FURTHER, Affiant(s) sayeth naught.

Date:

_______________________ _______________________
Witness  Beneficiary/Lender/Affiant
_______________________
Witness

 

_______________________ _______________________
Witness  Beneficiary/Lender/Affiant
_______________________
Witness

AFFIDAVIT OF PAYMENT HISTORY

(State of , County of ) SS:

Before me, a Notary Public in and for said state and county, personally came , the Affiant in the above instrument, who acknowledged the execution of same to be (his, her) free and voluntary act and deed.

In testimony whereof, I have hereunto subscribed my name and affixed my notarial seal at , on this day of ,19 .

Notary Public

 

(Seal)

(Exp. Date)

(State of , County of ) SS:

Before me, a Notary Public in and for said state and county, personally came , the Affiant in the above instrument, who acknowledged the execution of same to be (his, her) free and voluntary act and deed.

In testimony whereof, I have hereunto subscribed my name and affixed my notarial seal at , on this day of ,19 .

Notary Public

(Seal)

(Exp. Date)

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