STATE OF__________________

COUNTY OF ________________

Before me, the undersigned authority,  personally appeared ____________________________________

(attorney in fact/”Affiant”) who swore or affirmed that:

  1. Affiant is the Claimant in the Finder Contract executed by and between them and __________________________(hereinafter “Finder”) on ____________________date.
  2. The Finder has explained to Affiant the law on unclaimed properties, and that unclaimed property due to Affiant may be claimed without a fee, free and simple.


[signature of Affiant]

State of Kentucky

County of ___________

The foregoing instrument was acknowledged before me this ______ day of _______ (year), by ______________________ (name of person acknowledged).


(Signature of person taking acknowledgment)

(Title or Rank):__________________________

(Serial number, if any):____________________

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