Affidavit of Ownership

Affidavit of Ownership

Before you use this: Ask the person, agency, court, title office, insurer, lender, or other recipient whether it accepts a private affidavit and whether it requires its own form, a deed, a title document, a probate filing, a court order, a lien release, or another instrument. Describe the asset precisely, attach the records that support the statement, and use the recipient's required oath or affirmation certificate. Do not swear to a legal conclusion that you cannot support with the documents and facts.

Venue

State or other jurisdiction: [________________________________]

County or equivalent: [________________________________]

Affiant and purpose

I, [FULL LEGAL NAME], of [STREET ADDRESS, CITY, STATE, ZIP], state under oath or affirmation:

1. I am the person identified in this affidavit. If I am signing through an agent, fiduciary, entity, or other authority, that authority is: [DESCRIBE AUTHORITY AND ATTACH PROOF].
2. I make this affidavit for [NAME OF RECIPIENT] for the following purpose: [DESCRIBE THE SPECIFIC REQUEST OR TRANSACTION].
3. I have personal knowledge of the facts stated in this affidavit, except where I identify a record or another source.

Asset and ownership statement

4. The asset or property is: [DESCRIBE THE ASSET WITH ENOUGH DETAIL TO DISTINGUISH IT FROM OTHER PROPERTY].

5. Identifying information for the asset is:

6. I state that I own the interest described below in this asset: [DESCRIBE THE INTEREST AND PERCENTAGE, IF APPLICABLE].

7. My ownership statement is based on these facts:

• How the interest was acquired: [purchase / gift / inheritance / distribution / assignment / creation / other: __________]
• Date and place of acquisition: [________________________________]
• Person or entity from whom it was acquired: [________________________________]
• Document or event supporting acquisition: [IDENTIFY THE DOCUMENT, DATE, RECORDING OR ACCOUNT NUMBER, AND ATTACHED EXHIBIT]

8. The ownership history that I know is:

9. I currently possess or control the asset as follows: [DESCRIBE POSSESSION, CUSTODY, ACCOUNT CONTROL, OR OTHER FACTS; IF NONE, EXPLAIN].

10. Other persons or entities who may claim an ownership, security, lien, lease, beneficiary, marital, community-property, tenancy, trust, estate, or other interest are: [LIST EACH PERSON OR ENTITY, THE CLAIMED INTEREST, AND THE SUPPORTING DOCUMENT; STATE “NONE KNOWN” ONLY AFTER A REASONABLE RECORD REVIEW].

11. The following liens, loans, security interests, leases, restrictions, disputes, pending proceedings, or other limits are known to me: [LIST EACH ONE OR STATE “NONE KNOWN”].

12. The following records support the statements in this affidavit: [LIST EACH RECORD BY TITLE, DATE, RECORD OR ACCOUNT NUMBER, ISSUER, AND EXHIBIT LETTER].

Statement and signature

13. I have read this affidavit. The factual statements are true and correct to the best of my knowledge and belief. I have identified the source of any fact that is not based on my personal knowledge. I understand that the recipient may require additional evidence or a different instrument before accepting or recognizing the claimed ownership interest.

Affiant signature: [________________________________]

Printed name: [________________________________]

Date signed: [__/__/____]

Telephone or email for verification, if requested: [________________________________]

Exhibits

☐ Exhibit A: [________________________________]

☐ Exhibit B: [________________________________]

☐ Exhibit C: [________________________________]

☐ Other: [________________________________]

Notarial certificate

[NOTARIAL OFFICER: ATTACH OR COMPLETE THE JURAT OR OTHER CERTIFICATE REQUIRED BY THE JURISDICTION WHERE THE OATH OR AFFIRMATION IS ADMINISTERED. Use the recipient's required certificate, and complete the venue, date, affiant identity, oath or affirmation, signature, title, commission information, and seal as required there.]