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-8037 AFFIDAVIT OF OWNERSHIP AND INDEMNITY AGREEMENT The undersigned, being first duly sworn on oath says: 1. That I am the owner of unclaimed funds presently being held by Waukesha County and identified in the legal notice published by the Treasurer. 2. That proof of my ownership of such funds arises from the following facts: Check No. Amount 3. That I hereby request Waukesha County to pay such unclaimed funds to me and hereby agree to completely indemnify Waukesha County against any clai.

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