Printable Payment Affidavit
This Payment Affidavit is prepared to certify the completion of a financial transaction between the undersigned parties. The information below outlines the details of the payment and confirms receipt by the payee.
Prepared by: [YOUR NAME]
Email: [YOUR EMAIL]
I. Payer and Payee Information
Payer Name: Johann Harvey
Payee Name: WinGroup
Payee Address: Seattle, WA 98101
II. Payment Details
Amount Paid: $10,000
Payment Date: January 15, 2051
Method of Payment: Bank Transfer
Transaction Details | Information |
|---|
Bank Name | GoWorld Bank |
Transaction ID | FG2051TX00012345 |
Account Number | 987654321 |
III. Purpose of Payment
The payment was made to settle Invoice #2051-XYZ for the procurement of office supplies delivered on December 15, 2050. This payment fully satisfies the obligations under the specified invoice.
IV. Declaration
I, the undersigned, affirm under penalty of perjury that the details provided in this affidavit are true and accurate to the best of my knowledge.
Payer Printed Name: Johann Harvey
Date: January 16, 2051
Payee Printed Name: Sigmund Corwin
Date: January 16, 2051
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