STATE OF NORTH CAROLINA

File No.

__________________________ County

In the General Court Of Justice

Name of Plaintiff/Petitioner

CERTIFICATION OF IDENTITY

AND/OR NOTICE OF DEPOSIT

Name of Defendant/Respondent

NOTE TO CLERK: For bookkeeping purposes only; not to be placed in public file.

TO THE ClERK OF SUPERIOR COURT:

I certify that:

1. I am or represent:

an upset bidder in the above referenced matter.
a person authorized under G.S. 7A-111 to deposit funds with Clerk of Superior Court.
a person authorized to deposit funds with Clerk of Superior Court under a court order dated
in Count Case Number . (attach a copy of order if from a different county.)
a personal representative holding funds for minor under G.S. 28A-23-2.
a judgement creditor due funds held by Clerk of Superior Court.
a person due funds held by Clerk of Superior Court. (please provide a copy of your photo Id)
Other:(specify)

2. I am depositing funds in the amount of $
3. The identifying information of me and my clients as follows:
  1. Name and Address of Attorney

    North Carolina Attorney Bar No.

    Telephone No.

    Name of Firm

  2. Name and Address

    Date of Birth

    Telephone No.

    Tax ID/ Social Security Number

  3. Name and Address

    Date of Birth

    Telephone No.

    Tax ID/ Social Security Number

VERIFICATION

I, the undersigned, being first duly sworn, say that I have read this certification and the contents are true to my own knowledge

SWORN/AFFIRMED TO AND SUBSCRIBED BEFORE ME

Date

Date

Signature Of Person Authorized To Administer Oaths Signature Of Person Signing Certification
Deputy CSC Assistant CSC Clerk of Superior Court
Notary Date My Commission Expires
SEAL County Where Notarized

AOC-G-120, Rev. 4/09
© 2009 Administrative Office of the Courts