PERSONAL INFORMATION AFFIDAVIT MISTAKEN IDENTITY STATE OF OHIO ______________COUNTY I, _________________________, being first duly sworn according to law, depose and say that: 1. My residence and/or business addresses for the past ten (10) years have been as follows: ______________________________________________________________________________ ______________________________________________________________________________ 2. My Social Security Number is___________________________________________________ 3. My date of birth is____________________________________________________________ 4. My spouse or spouses during the past ten (10) years have been: ______________________________________________________________________________ 5. I have never resided at, done business at, or received mail at the following addresses: ______________________________________________________________________________ ______________________________________________________________________________ 6. I have reviewed the following Judgment Liens and Tax Liens and I am not the party named as debtor in the following Judgment Liens and/or Tax Liens (insert Volume and Page and Judgment Liens and File Number of Tax Liens): _________________________ _________________________ _________________ _________________________ _________________________ _________________ _________________________ SIGNATURE Sworn to before me and subscribed in my presence this _____ day of _______, 20______. _________________________ Notary Public American LegalNet, Inc. www.USCourtForms.com