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Bulk Sales Affidavit

(SALES OF ASSETS & LIST OF CREDITORS)

State of _____________

County of ___________

____________, of lawful age, being first duly sworn, on oath states:

That he/she is the Seller in that certain contract for the sale of assets dated __________,20 _ between himself/herself, as Seller, and ________________ as Buyer;

That this Affidavit is made pursuant to the terms and provisions of the Uniform Commercial Code and is furnished to the above named Buyer in connection with the sale and transfer described and referred to in the above mentioned contract;

That the following is a true, complete and accurate list of all of the creditors of affiant and of all persons who, to the knowledge of affiant, assert or have claimed to assert one or more claims against affiant, together with the correct business addresses of each such creditor or claimant and the amounts due and owing to such creditors and claimants, to wit:

Name of Business Amount Admitted or

Creditor Address Of Claim Disputed

1. ____________ ___________ ___________ ____________

2. ____________ ___________ ___________ ____________

3. ____________ ___________ ___________ ____________

________________________

Signature

SUBSCRIBED and sworn to before me this ___________ day of _________, 20__.

____________________________

Notary Public

My commission expires: _______________ 20 ___.

_____________________________

[Notarial Seal]