BULK SALES AFFIDAVIT State of _________________________________ County of ________________________________ ____________________________, of lawful age, being first duly sworn, on oath states: _________________________________________ _________________________________________ _________________________________________ That he is the Seller in that certain contract for the sale of assets dated ___________,20__ between himself, as Seller, and ___________________ as Buyer; That this Affidavit is made pursuant to the terms and provisions of the Uniform Commercial Code and is furnished to the above named Buyer in connection with the sale and transfer described and referred to in the above mentioned contract; That the following is a true, complete and accurate list of all of the creditors of affiant and of all persons who, to the knowledge of affiant, assert or have claimed to assert one or more claims against affiant, together with the correct business addresses of each such creditor or claimant and the amounts due and owing to such creditors and claimants, to wit: Name of Business Amount Admitted or Creditor Address Of Claim Disputed 1.____________ ___________ ___________ ______________ 2.____________ ___________ ___________ ______________ 3.____________ ___________ ___________ ______________ __________________________ (Signature) SUBSCRIBED and sworn to before me this _______ day of _________, 20__. _________________________ Notary Public My commission expires: _____________________________ [Notarial Seal] Form 337