STATE OF INDIANA )
) SS:
COUNTY OF__________ )
FILE NUMBER __________________
AFFIDAVIT OF NO BROKER
__________________________ (“Affiant”), upon first being duly sworn upon his oath, says:
1. That Affiant is the ___________________[owner, lessee, buyer,] of the following described property:
[Insert legal description]
Commonly known as:
2. Affiant states that there is no written agreement by and between Affiant and a commercial real estate broker for the sale, purchase, lease or other conveyance of the above-described property.
3. Affiant has no knowledge of any other brokers involved in the sale, purchase, lease or other conveyance of the above-described property.
4. The aforementioned statements are made for the purpose of inducing [name of title insurance company and title insurer] to insure the sale, purchase, lease or other conveyance of the above-described property without taking exception to a broker's lien pursuant to I.C. 32-28-12.5
5. That furthermore Affiant saith not.
_____________________________________________
ACKNOWLEDGMENT
STATE OF INDIANA )
)SS:
COUNTY OF ________________ )
Subscribed and sworn to before me the undersigned Notary Public in and for said County and State this ____ day of ______________, 200_, personally appeared ______________________, ___________________. and acknowledged the execution of the foregoing Scrivener's Affidavit, and who, having duly been sworn, stated that any representations therein contained are true.
My Commission Expires: ___________________________________
Notary Public
___________________________________
Printed
Residing in _______________ County,
State of Indiana
No guidelines are available for this form at this time.