Revocation of Signature For Loan Appilcation

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Oakland county )

) Asservation
the State of Michigan )
) L.S. ____________________________________{SEAL}
The united States of America )

The Affiant, having attained the age of majority, competent to testify, a self-realized being, a free man upon the land, my yes
be yes, my no be no, do herby solemnly state that the truths and facts herein are of firsthand personal knowledge, and true,
correct, complete, certain, and not misleading, so help me God.

AFFIDAVIT OF REVOCATION OF SIGNATURE FOR GOOD CAUSE

Introductory Certification

The Affiant having full first-hand knowledge of the facts stated herein, and making this Affidavit of His own free Will, does
affirm that the facts stated herein are true, correct, certain, and complete to the best of His knowledge. Affiant further
states:
Plain Statement of Facts

1. THAT, Affiant affixed His signature to documents on or about 12/04, without knowledge that a fraud
was being perpetrated upon Him.
2. THAT, Affiant was actually misled and coerced into signing the aforementioned documents, without
knowledge of the fraud that was being perpetrated upon Him.
3. THAT, Affiant, aware of the fact that fraud vitiates all contracts, agreements and documents, believes
the contract with STATE FARM BANK is void and nonexistent.
4. THAT, Affiant revokes all signatures for good cause, and "Without Recourse to Me" pursuant to UCC
3-501.
5. THAT, Affiant has, by this Affidavit, formally and timely removed the aforementioned signature(s) for
all time and thereby removes any nexus, actual or presumed, that STATE FARM BANK may believe
it has with Affiant by virtue of said signature(s) and or contract(s).

Verification

Any man or woman having first hand knowledge of all the facts asserted herein and having absolute power and authority to
rebut this affidavit must rebut with the rebutting party’s own signature and endorsement notarized, under the penalty of perjury
and willing to testify, and executed as true, correct, and complete with positive proof attached. Absent positive proof any
rebuttal shall be deemed null and void having no force or effect, thereby waiving any of State Farm Bank’s immunities or
defenses.
Any rebuttal shall be mailed to the undersigned and the Notary address within ten (10) calendar days of State Farm Bank’s
receipt of this affidavit. When a rebuttal is not received by both the Affiant and the Notary within 10 days this entire Affidavit
and default provisions shall be deemed true and correct.

This Affidavit of Revocation of Signature for Good Cause is dated the ________________ Day of the _________
Month in the Year of Our Lord Two Thousand Five [October 21, AD 2005].

________________________________________ SEAL
Larry Brintley Jr

Form # LBJ102105-SR Page 1 of 2


Jurat
State of Michigan )
) ss.
County of Oakland )

Subscribed and sworn to at _____________________ before me this _____ day of ________________, A.D. _____.

Notary public ____________________________________

My Commission Expires _____________________________

WITNESS my hand and official seal.

_________________________________________________
Signature of Notary Public

Form # LBJ102105-SR Page 2 of 2

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