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  1.  
  2.                                BULK SALES AFFIDAVIT
  3.  
  4.  
  5.  
  6.         State of _________________________________
  7.  
  8.         County of ________________________________
  9.  
  10.  
  11.  
  12.                 ____________________________, of lawful age, being first 
  13.         duly sworn, on oath states:
  14.  
  15.                     _________________________________________
  16.  
  17.                     _________________________________________
  18.  
  19.                     _________________________________________
  20.  
  21.                 That he is the Seller in that certain contract for the 
  22.         sale of assets dated ___________,19__ between himself, as Seller, 
  23.         and ___________________ as Buyer;
  24.  
  25.                 That this Affidavit is made pursuant to the terms and 
  26.         provisions of the Uniform Commercial Code and is furnished to the 
  27.         above named Buyer in connection with the sale and transfer 
  28.         described and referred to in the above mentioned contract;
  29.  
  30.                 That the following is a true, complete and accurate list 
  31.         of all of the creditors of affiant and of all persons who, to the 
  32.         knowledge of affiant, assert or have claimed to assert one or 
  33.         more claims against affiant, together with the correct business 
  34.         addresses of each such creditor or claimant and the amounts due 
  35.         and owing to such creditors and claimants, to wit:
  36.  
  37.            Name of          Business        Amount         Admitted or
  38.            Creditor         Address         Of Claim       Disputed
  39.  
  40.         1.____________      ___________     ___________    ______________
  41.  
  42.         2.____________      ___________     ___________    ______________
  43.  
  44.         3.____________      ___________     ___________    ______________
  45.  
  46.  
  47.                                                __________________________
  48.                                                (Signature)
  49.         
  50.                 SUBSCRIBED and sworn to before me this _______ day of 
  51.         _________, 19__.
  52.  
  53.                                                 _________________________
  54.                                                 Notary Public
  55.  
  56.  
  57.         My commission expires:
  58.  
  59.         _____________________________
  60.         [Notarial Seal]                         Form 337
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  72.