A. Notwithstanding the provisions of R.S. 13:841 et seq. the clerks of the several district courts shall provide to any person who makes a request the following affidavit and acknowledgment form and shall notarize and record the affidavit subject to a fee to be established by the clerk or the recorder of mortgages. B. The affidavit and the acknowledgment concerning the distinction or identity of a person shall comply with the requirements of R.S. 9:5501 and 5503 if it provides all the information required or set forth in the following form: I, (Affiant) , being of sound mind acknowledge and understand that any intentional falsification of information I am about to provide shall subject me to penalties for the crime of injuring public records and false swearing. My full name is . I am years old and I was born on (Month) (Day) (Year) at (City, Parish/County and State of Birth) . My social security number is . I presently reside at and my previous addresses for the preceding 10 years were , . Name and address of my employer ; Name and address of location of employment ; Occupation ; Marital status , If married full name of spouse (Maiden name if applicable) ; spouse's social security number . I HEREBY AFFIRM AND ATTEST, under penalty of law, that I am not the same person as the debtor or debtors named in the following described recorded judgments, liens, privileges, or mortgages: (1) (Identification of recorded judgments, liens, privileges, or mortgages.) I HEREBY FURTHER AFFIRM AND ATTEST, that on the ____ day of _____________,______, I mailed a copy of the affidavit to each judgment creditor listed in the affidavit at his last known address by registered mail and hereby submit proof of said certified mailing. I HEREBY FURTHER AFFIRM AND ATTEST, that the Judgment Creditor has failed to comply with R.S. 9:5501 and I hereby execute this affidavit of identity to establish that I am not the same person identified as the debtor in the said recorded judgments, liens, privileges, mortgages or other such documents itemized above. Thus done, read and signed at ____________________, State of Louisiana, this ______day of __________, _______. I,(we), (Name of Judgment Creditor ) hereby acknowledge that the above named affiant is not the same person identified or named in the above identified or described (judgment, lien, privilege, or mortgage) and that the property of the affiant is not subject to the judicial mortgage resulting from the judgment. Thus done, read and signed at , State of Louisiana, this day of the month of , . Acts 1997, No. 1200, §1. STATE OF LOUISIANA PARISH OF AFFIDAVIT Before me, the undersigned authority , personally came and appeared: (Affiant) , (marital status and mailing address ), who after being duly sworn, deposed as follows: WITNESSES: ________________________ Notary Public Acknowledgment Notary Public
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