Before me, the undersigned authority, a notary public in and for this county and state, personally appeared _________ and wife, _________, who, after being duly sworn on oath by me, did each depose and say:

We further state that we are also the owners of:

We here now state that we do not reside, occupy, use or claim the last above-described property as our homestead property. We further state that we have removed from it all our furniture, household goods and personal effects of whatever description; and that we now have and hold no manner of homestead claim against the last above-described property.

We make this affidavit as an inducement to _________ company of _________, a corporation, to extend to us a loan upon the security of the lot _________ and the west _________ of lot _________, in block _________, _________ addition _________ upon the security of our two certain deeds of trust of this date to _________, trustee, recorded in the deeds of trust of this date to _________, trustee, recorded in the deed of trust records of _________ County, _________.

Executed this _________, 19__.