Rec 1.41 - Affidavit Of Independent Escrow Agent
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2North Carolina Real Estate Commission
P.O. Box 17100, Raleigh, N.C. 27619-7100
Phone (919) 875-3700 • E-mail: RA@ncrec.gov
Website:
AFFIDAVIT OF INDEPENDENT ESCROW AGENT
FOR FINANCIAL INSTITUTION
I, the undersigned, being first duly sworn, affirm that:
1. I am authorized to represent a financial institution located in North Carolina; and
2. I hereby accept appointment as of the date shown below as Independent Escrow Agent for the registered time share
project named below; and
3. I have read and fully understand the provisions of the North Carolina Time Share Act (Article 4, G.S. 93A) which
sets forth the duties and responsibilities of Independent Escrow Agent; and
4. I will, in furtherance of the responsibilities as Independent Escrow Agent, deposit and maintain in a trust or escrow
account in an insured bank or savings and loan association located in this State all payments made by purchasers
on account of time shares purchased at the project named below, and shall return such payments to the purchasers
after 120 days following the purchasers' execution of their time share purchase contracts unless, prior to that time,
a lien-free or lien-subordinated time share instrument to such time share has been recorded; and
5. I acknowledge the responsibility to make available to the North Carolina Real Estate Commission or its
representatives all records relating to monies held in the capacity as Independent Escrow Agent; and
6. I agree to immediately notify the North Carolina Real Estate Commission upon the termination of the appointment
as Independent Escrow Agent for the below-named project.
_______________________________________________________ ________________________________
Time Share Project Name
Time Share R egistration Num ber
______________________________________________________________
Name of the Financial Institution
______________________________________________________________________________
Address of Financial Institution
By: _________________________________________
___________________________________
Name and Title (President or Vice President)
Signature of person executing affadavit
of person executing affidavit
Attest: _______________________________________
___________________________________
Name and Title (Secretary or Assistant Secretary)
Signature of person attesting to affidavit
of person attesting to execution of affidavit
STATE OF___________________________
COUNTY OF________________________
I, ___________________________________________a Notary Public for said County and State certify that
__ personally came before me this day and acknowledged
that he/she is
of
and
acknowledged on behalf of
, the due execution of the foregoing
instrument.
Witness my hand and official seal, this the
day of______________________, 20_______.
[NOTARY SEAL]
______________________________________
Signature of Notary Public
My Commission expires: ______________________
REC 1.41
3/15
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