Registration and Affidavit

Office of the Pulaski County Collector

Terri L. Mitchell, Collector of Revenue 301 Historic Route 66 East, Ste.110

Phone: 573.774.4711 Fax: 573.774.4722 Waynesville, MO 65583

Registration and Affidavit

2008 Pulaski County Tax Certificate Sale
August 25, 2008

Instructions:

Complete this registration form and submit before 10:00 a.m., August 25, 2008. Sign in the presence of a notary public (Collector’s Office will provide this service).

Name: ______________________________________________________________

Address: _____________________________________________

_____________________________________________

_____________________________________________

Phone: ______________(Home) _____________(Work) _____________(Cell)

Email Address (optional): _________________________

How Certificates/Deeds are to be titled (Please Print):

Name(s) _________________________________________________________

· I understand that if I am not a resident of Missouri, I must follow State Statutes 140.190 RSMo. I have attached the proper documents.

· I am not delinquent on any tax bills, Personal Property or Real Estate, in accordance with RSMo 140.190.

· I understand that if Certificates/Deeds are to be titled in other names, I have attached the proper documents.

I understand that the Collector’s Office follows Chapter 140 of the Missouri State Statutes and I am responsible for understanding their contents. The Collector’s Office is not responsible for interpreting the statutes for me.

I understand that by signing, I am swearing the information given is true. A false affidavit will invalidate any purchase made by me.

Bidder Signature: ___________________________________ Date: ___________

Bidder Signature: ___________________________________ Date: ___________

In witness hereof the undersigned has executed this Affidavit and has affixed his/her

hand this _______________ day of _________________ , 20____.

Subscribed and sworn before me this _________ day of ____________ , 20___.

_______________
My Commission Expires

___________________________
Notary Public

For Office Use Only

_____ __________
Initials Bidder #