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Y <br /> TO BE FILLED IN PERSONALLY <br /> BY SELLER OR BORROWER IN HIS OWN HANDWRITING <br /> INDEMNITY AND AFFIDAVIT AS TO DEBTS, LIENS, AND POSSESSION <br /> USE SEPARATE FORM FOR EACH PARTY <br /> STELLA A . ARENDAS, AS TRUSTEE of the STELLA A. ARENDAS REVOCABLE TRUST OF 6/4/93 , as to an undivided one- <br /> half interest AND in STELLA A. ARENDAS, as trustee of the ELMER J . ARENDAS CREDIT SHELTER TRUST, as to an <br /> undivided one-half interest <br /> Seller or Owner-Borrower <br /> Contractor (if new construction) <br /> INDIAN RIVER COUNTY, a political subdivision of the State of Florida <br /> Purchaser <br /> personally known to me to be the person whose name is subscribed hereto, and upon his oath deposes and says : <br /> I, the seller, owner-borrower, and/or contractor, represent to the purchase and/or lender in this transaction <br /> that to my <br /> knowledge there are: <br /> 1 . No unpaid debts for plumbing fixtures, water heaters, floor furnaces, air conditioners, radio or television antennae, <br /> carpeting, rugs, lawn sprinkling systems, venetian blinds, window shades, draperies, electric appliances, fences, street <br /> paving, or any personal property or fixtures that are located on the subject property described above, and that no such <br /> items have been purchased on time payment contracts, and there are no security interests on such property secured by a <br /> financing statement, security agreement or otherwise except the following: (If none, so state.) <br /> NAMEr AI ADDRESS OF SECURED PARTY Approximate Amount <br /> 2. No loans of any kind on said property except the following: (If none, so state.) <br /> AME AND ADDRESS OF CREDITOR Approximate Amount <br /> 3 . All labor and material used in the construction of improvements or repairs on the above described property have been <br /> paid for and there are now no unpaid labor or material claims against the improvements or the property upon which the <br /> same are situated, and I hereby declare that all sums of money due for the erection of improvements or repairs have been <br /> fully paid and satisfied, except: (If none, so state.) <br /> NMEQ1 ADDRESS OF SUPPLIER OF LABOR, SERVICES OR MATERIALS Approximate Amount <br /> 4 . 1, the purchaser, represent that I have no knowledge of any debts or liens of any kind other than those listed above, except: <br /> (If none, so state.) <br /> NAME AND ADDRESS OF SECURED PARTY, CREDITOR, SUPPLIER OF Approximate Amount <br /> LABOR OR MATERIALS <br /> Page 1 of 3 <br />