I, , swear or affirm:
1. That I am the Owner of , located in , .
2. That on , , (“”) brought his to my auto repair shop for an estimate.
3. That explained to me at that time that he had been in an accident and said that the other vehicle owner caused it, and that insurance company would be paying for the repair.
4. That I have estimated the cost of repair to ’ to be $, and that said estimate is attached as exhibit A.
Further affiant saith not.
I SWEAR OR AFFIRM THAT THE ABOVE AND FOREGOING REPRESENTATIONS ARE TRUE AND CORRECT TO THE BEST OF MY INFORMATION, KNOWLEDGE, AND BELIEF.
I, the undersigned Notary Public, do hereby affirm that personally appeared before me on the day of , and signed the above Affidavit as his free and voluntary act and deed.
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