Form 1027 (Formerly L-4421) - Annual Report For Car Loaning, Stock Car, Refrigerator And Fast Freight Line Companies And Other Car Companies - 2001 Page 6

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7
OATH
(To be made by the officer having control of the accounting of the respondent)
STATE OF
COUNTY OF
makes oath and says that he/she
(Insert here the name of the affiant)
(Insert here the official title of the affiant)
of
(Insert here the exact legal title or name of the respondent)
that it is his/her duty to have supervision over the books of account of the respondent and to control the manner in
which such books are kept; that he/she has carefully examined the said report and to the best of his/her knowledge
and belief the entries contained in the said report have, so far as they relate to matters of account, been accurately
taken from the said books of account and are in exact accordance therewith; that he/she believes that all other
statements of fact contained in the said report are true, and that the said report is a correct and complete statement of
the business and affairs of the above named respondent during the period of time from and
including _________________________, 20 ____, to and including _________________________, 20 ____.
,
(Signature of affiant)
Subscribed and sworn to before me,
, in and for the State
county above named, this ____________________________ day of _________________________, 20 ____.
My commission expires ____________________________
Use an L.S.
Impression
Seal
(Signature of officer authorized to administer oath)

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