Affidavit SAMPLE of BC Beneficial Ownership Wi Photo

AFFIDAVIT  OF BIRTH CERTIFICA CE RTIFICATE TE BENEFICIAL OWNERSHIP One, Last: First-Middle, ri!ate "an#$%"an, n%t an entit&, nati%nal %' t(e )nited States %' A"eri*a, t(e E+e*t%r#ene'i*iar& '%r t(e Estate Trst Trst %' .FIRST MIDDLE LAST/0 a Pli* Re1ister State A1en*&, A1en*&, & t(e %$ers !ested in trst, (ere& *erti'& t(at I a" 'a"iliar $it( t(e 'a*ts re*ited el%$2 and t(at2 34 T(e E+e*t%r is a  ene'i*iar& %' t(e a1e %' "a5%rit&2 and t(at2 64 T(e art& na"ed in said .Birth Certificate 0 atta*(ed, n%t n %t %''i*ial 5st *erti'ied *%&, and "ade art (ere%', is t(e sa"e art& as t(e At(enti*ated Re1ister Bene'i*iar&#E+e*t%r na"ed in t(is A''ida!it: .FIRST MIDDLE LAST/0 a Pli* P li* Re1ister State A1en*&, A1en*&, Estate, (eld in Trst, Trst, Birth Certificate  N%4 777-77-777777, re1istered in STATE OF 89O)R STATE, DEPARTMENT OF HEALTH, DIVISION OF VITAL STATISTICS $it( State Re1istrar in 8&%r Cit&, State2 and t(at2 ;4 T(e E+e*t%r is sin1 t(is A''ida!it A''ida!it t% d%*"ent t(e stats %' a seri%r lien %!er t(e  rin*ile, interest, and all a**%nts se*red & t(e atta*(ed Birth Certificate  and t(e r%ert& t% $(i*( it relates '%r '%r .FIRST MIDDLE LAST /0 a Pli* Re1ister State A1en*&, Estate, Estate, (eld in Trst2 and t(at2 <4 T(e E+e*t%r (as at(enti*ated t(e .FIRST MIDDLE LAST /0 a Pli* Re1ister State A1en*&, Estate, (eld in Trst2 and t(at2 =4 Last: First-Middle, ri!ate real "an, n%t an entit&, entit&, (as resi1ned resi1ned as resident a1ent and re1ister %''i*e 8MCL <=>436<;, Mi*(i1an '%r t(e .FIRST MIDDLE LAST/0 a Pli* Re1ister State A1en*&, Estate, (eld in Trst2 and t(at2 ?4 T(e E+e*t%r@s state@s state@s t(e da& %' irt(  irt( is M%nt( date, &ear2 and t(at2 4 T(e E+e*t%r@s state@s state@s t(e la*e %' irt( is near t(e 1e%1ra(i*al l%*ati%n *%""%nl& n%$n as Detr%it, Mi*(i1an, an entit& '%r"ed $it(in t(e *%nstitti%nal reli* %' t(e )nited States %' A"eri*a, in an %tl&in1 %ssessi%n %' t(e )nited States2 and t(at2 4 T(e E+e*t%r is t(e (%lder in de d e *%rse se*rin1 3>> %' t(e ene'i*ial interest in t(e  r%ert&,  r%ert&, .FIRST MIDDLE LAST/0 a Pli* Re1ister State A1en*&, Estate, Estate, (eld in Trst t% $(i*( t(is a''ida!it relates, and t(at2 4 T(e E+e*t%r (as t(e s%le %$er  %$er t% a**et, re*ei!e, trans'er, disrse, %r *%n!e& 3>> %' t(e  r%*eeds r%'its, in*%"e, and re!ene arisin1 %t %' t(e r%ert& %' .FIRST MIDDLE LAST/0 a Re1ister State A1en*&, A1en*&, Estate, (eld in Trst relates2 and t(at,

3>4 T(e E+e*t%r (%lds all in!est"ent %$ers, $(i*( in*ldes t(e %$er t% dis%se, %r t% dire*t t(e dis%siti%n %', s*( %rti%n %' t(e .FIRST MIDDLE LAST/0 a Pli* Re1ister State A1en*&, Estate, (eld in Trst2 and t(at, 334 T(e E+e*t%r at(%ries t(is a''ida!it t% e r%!ided t% an& $it((%ldin1 a1ent#n%"inee t(at (as *%ntr%l, re*eit %r *st%d& %' t(e r%'its, r%*eeds, re!ene, (%lder %' t(e d et instr"ent %r in*%"e deri!ed 'r%" t(e r%ert& s5e*t t% t(e atta*(ed .FIRST MIDDLE LAST/0 a Pli* Re1ister State A1en*&, Estate, (eld in Trst4 364 T(e E+e*t%r s(all als% %!erstand 1%!ern"ent entities and r%'itale *%r%rati%ns related t% t(e .FIRST MIDDLE LAST/0 a Pli* Re1ister State A1en*&, Estate, (eld in Trst $it( an ass%*iated S%*ial Se*rit& N%4 8SSN 777-77-77774 All %ints "enti%n a%!e alied t% t(e SSN as $ell4 3;4 T(e E+e*t%r s(all a*n%$led1e t(e atta*(ed At(enti*ated State %' Mi*(i1an .Certificate of Authority0 seal, re*%rded G777777-7-777777-7774 3<4 T(e E+e*t%r s(all a*n%$led1e t(e atta*(ed At(enti*ated )nited States %' A"eri*a, Deart"ent %' State .Certificate of Genuineness 0 F%rei1n seal, re*%rdedG77777777-74 3=4 T(e E+e*t%r ein1 an O**ied %' t(e O''i*e %' t(e .FIRST MIDDLE LAST/0 a Pli* Re1ister State A1en*&4 Bel%$ is a i*tre %' t(e li!in1 "an, E+e*t%r4

I (ere& de*lare nder enalt& %' er5r& t(at t(e a%!e in'%r"ati%n is *%"lete, *%rre*t, and tre t% t(e est %' "& n%$led1e and la$4 8Seal at%1ra( &  Last: First-Middle, E+e*t%r Date .FIRST MIDDLE LAST /0 a Pli* Re1ister State A1en*&, Estate

)RAT STATE OF 89O)R STATE CO)NT9 OF 89O)R CO)NT9

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 ___________  On  e'%re "e,    , .N%tar& Pli*0, ers%nall& aeared e'%re "e Last: First-Middle, $(% r%!ed t% "e %n t(e asis %' satis'a*t%r& e!iden*e with _Passport _ID & Photo type t% e t(e "an $(%se na"e is ss*ried t% $it(in t(is instr"ent and a*n%$led1ed t% "e t(at (e e+e*ted t(e sa"e in (is at(%ried *aa*it& and t(at  & (is at%1ra( %n t(e instr"ent, t(e "an a*ted, e+e*ted t(e instr"ent4

I *erti'& nder PENALT9 OF PER)R9 nder t(e la$s %' t(e State %' Your State t(at t(e '%re1%in1 ara1ra( is tre and *%rre*t4

WITNESS "& (and and %''i*ial seal4

Si1natre 

8Seal