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Below is a cache of http://www.dallascounty.org/department/treasurer/documents/CT-84.pdf. It's a snapshot of the page taken as our search engine crawled the Web.
The web site itself may have changed. You can check the current page or check for previous versions at the Internet Archive. Yahoo! is not affiliated with the authors of this page or responsible for its content. DALLAS COUNTY 509 MAIN STREET ! 303 RECORDS BUILDING ! DALLAS, TEXAS 75202 ! (214) 653-7321 Jcwells@dallascounty.org
DALLAS COUNTY CT-84
JOE WELLS COUNTY TREASURER
AFFIDAVIT OF FORGERY-MAKER OR ENDORSER STATE OF _______________
COUNTY OF _____________
(Name)______________________________ residing at ____________________________
states he/she has inspected Dallas County Check#______________ Fund# _____________
dated ______________ drawn on (bank)________________________________________
payable to the order of ______________________________________________________
in the sum of $__________________________ is a forgery which was unauthorized
by_______________________________________ and that _________________________
did not benefit by reason of the payment thereof.
Before me __________________________________________________________
On this day personally appeared _________________________________________
Known to me (or proved to no on the oath of _________________________________)
To be the person whose name is subscribed to the foregoing instrument and acknowledge
To me that he executed the same for the purposes and consideration therein expressed.
(Signature)___________________________
Subscribed and sworn to before me this _______ day of _______________
(Notary)______________________________
The web site itself may have changed. You can check the current page or check for previous versions at the Internet Archive. Yahoo! is not affiliated with the authors of this page or responsible for its content. DALLAS COUNTY 509 MAIN STREET ! 303 RECORDS BUILDING ! DALLAS, TEXAS 75202 ! (214) 653-7321 Jcwells@dallascounty.org
DALLAS COUNTY CT-84
JOE WELLS COUNTY TREASURER
AFFIDAVIT OF FORGERY-MAKER OR ENDORSER STATE OF _______________
COUNTY OF _____________
(Name)______________________________ residing at ____________________________
states he/she has inspected Dallas County Check#______________ Fund# _____________
dated ______________ drawn on (bank)________________________________________
payable to the order of ______________________________________________________
in the sum of $__________________________ is a forgery which was unauthorized
by_______________________________________ and that _________________________
did not benefit by reason of the payment thereof.
Before me __________________________________________________________
On this day personally appeared _________________________________________
Known to me (or proved to no on the oath of _________________________________)
To be the person whose name is subscribed to the foregoing instrument and acknowledge
To me that he executed the same for the purposes and consideration therein expressed.
(Signature)___________________________
Subscribed and sworn to before me this _______ day of _______________
(Notary)______________________________
