(b) [Name of tax debtor] BE IT KNOWN, on the ________day of______________ [MONTH], _________ [YEAR],
BEFORE ME, the undersigned notary public, duly qualified in and for the state and parish aforesaid, and in the presence of the undersigned competent witness, PERSONALLY CAME AND APPEARED:
__________________________________ [name of affiant], major domiciliary of the Parish of __________________________________, State of Louisiana ("affiant"), who, after being duly sworn, deposed and stated that on his personal knowledge:
1. Affiant personally examined [name of abstract] [title certificate] [the public records] (the "abstract") affecting the following described immovable property located in the Parish of ___________________, State of Louisiana (the "property"): [Legal description of property]
2. A review of the abstract by the Affiant revealed the following persons or entities with an interest in the property, which such interest being listed beside the name: Name | Interest in property | Recordation information |
3. Affiant reviewed the documents listed in the abstract, the telephone book published by [name of telephone book publisher] for the Parish of __________________ dated for use until [date], and utilized all the resources under [list other examination resources, including Internet search engines, if any], and the search revealed the following last known addresses for the persons listed in Item 2 above: 4. Affiant reviewed the records of the Louisiana Secretary of State and the secretary of state of the states set forth by the names of the entities listed below, and the search revealed the following addresses for the entities listed in Item 2 above: 5. Affiant caused to be sent a written notice notifying the persons or entities listed in Item 2 above at the addresses listed in Items 3 and 4 above. A sample of the form of the written notice is attached and satisfied R.S. 47:2206(A).6. The method and results of the notifications set forth in Item 5 above are listed by name and address as follows: 7. Notification was also published in [journal of general circulation for the political subdivision] on [list dates] [and was posted on the property]. The form of the publication is attached and satisfied R.S. 47:2206(B).8. Pursuant to R.S. 47:2208(C), the following interests are cancelled, terminated, erased or released, as applicable, only insofar as they affect the Property: Name of interest holder | Name of instrument | Recordation information |
THUS DONE AND PASSED on the day, month and year set forth above, in the presence of the undersigned competent witness, who have signed their names with affiant, and me, Notary, after reading of the whole.
WITNESSES:
AFFIANT:
_____________________________
________________________________
Printed Name: _________________
Printed Name: ____________________
_____________________________
Printed Name: _________________
_____________________________________
NOTARY PUBLIC
Printed Name:_______________________
Notary/Bar Roll No.:__________________"