Forgery Affidavit

In the case of forgery, the following affidavit can be carried out by the affiant in that forgery case.

Extracted Text for Proper Search

BPS-8920 (1-02)
DHHS Controller's Office	
FORGERY AFFIDAVIT	
State of North Carolina	
Countybeing duly sworn, depose and say as	
I,
follows:	
dated
That I am payee named in a certain check number	1 .	
in the amount of $  	drawn by the State of North Carolina on the	
fund.	
That I have been advised by the  	County Department of	2.	
Social Services that the check mentioned above was cashed.	
3. 	That the endorsement on said check is not my handwriting. I have not at
any time authorized anyone to endorse the check on my behalf.	
4. 	That I have not received any part of the proceeds of said check.	
5. 	That I make this affidavit fully realizing the county department of
social services relies upon the truth of the statements herein contained\
.
I hereby agree to cooperate with law enforcement authorities in the
apprehension and prosecution of the person or persons who negotiated
check issued to me by the North Carolina Division of Social Services.	
6.  	I do hereby authorize the county department of social services to turn
over a signed copy of this affidavit to the appropriate authorities or
law enforcement agencies.	
Signature
Witness	
.	20	Sworn to and subscribed before me this	day of
Notary Signature	
(Seal)	
My Commission Expires
Program  	Account #	County #	
Date
Complete in Triplicate and send to:	2019 Mail Service Center
client
File