AFFIDAVIT

STATE OF FLORIDA COUNTY OF [lien.county]

[lien.vehicle_year] [lien.vehicle_make] VIN: [lien.vehicle_vin].

PROPOSED COMPLETION DATE: [lien.completed_date]

CUSTOMER NOTIFIED ON: [lien.completed_date]

THIS IS TO CERTIFY THAT THE COST OF REPAIRS ON THE ABOVE

DESCRIBED VEHICLE WERE LESS THAN $100.00 THE REPAIR

SHOP IS NOT REQUIRED TO SUBMIT A REPAIR ORDER.

Acknowledge before me this [Date.Today]  

For:  [lienor.company_name]

Signature:____________________________

Personally Know

________________________________

Notary Public