AFFIDAVIT OF OWNERSHIP OF CERTIFICATE OF TITLE FOR BENEFIT OF OWNER

I, __________, the affiant, of lawful age and being first duly sworn on oath, depose and state that I am
familiar with the facts recited, and the party named
in said birth certificate is the same
party as one of the owners named in said certificate of title.
State of_____________ }
} SS
County of __________ }
RE: Birth Certificate
__________________________________
Signature
UCC 1-308

JURAT
Subscribed and sworn to (or affirmed) before me on this______day of_______2015,
by______________________ proved to me on the basis of satisfactory evidence to
be the person(s) who appeared before me

Notary (Seal)

Notary Signature____________________