Folio #39440160005 (Trust Certification Affidavit)INSTR 4687563 OR 4791 PG 3326
This Instrument Prepared by: RECORDED 5/1/2012 12:04 PM PAGES
Collier County Real Property Management COLLIER E. ROC FL CLERK OF THE CIRCUIT COURT
3335 Tamiami Trail East — Suite 101
Naples, Florida 34112 -5356 REC $18.50
NE Wellfield
Folio # 39440160005
Trust Certification Affidavit Pursuant to F.S. 736.1017
File No.: Stewart Title Company — 1200195 -1301
STATE OF FLORIDA
COUNTY OF
Before me, the undersigned authority, after having been duly sworn, personally appeared JEAN COHEN,
hereinafter referred to as the Affiant herein, who deposes and states as follows:
1. Affiant is the current Trustee of the JEAN COHEN REVOCABLE TRUST DATED
SEPTEMBER 28, 1976, as Amended and Restated on October 17, 2011, hereinafter referred to
as the "Trust." Further that the Trust exists, and the settler (creator) of the Trust was JEAN
COHEN.
2. That Affiant resides at P.O. Box 654, Bonita Springs, Florida 34133, and that the subject
property ( ) is or ( XX ) is not Affiant's, nor any member of Affiant's immediate family's
homestead, nor contiguous thereto. Further that if subject property is Affiant's homestead his /her
spouse will join in the conveyance this affidavit accompanies.
3. Affiant certifies that this certification of trust pertains to the trust property located at:
Tract 3, Unit 52 GOLDEN GATE ESTATES, according to the Map or Plat thereof
as recorded in Plat Book 7, Page 92, of the Public Records of Collier County, Florida.
4. That Affiant is the current acting trustee.
5. Affiant as Trustee has full powers under the aforesaid Trust via a general power of sale to sell,
convey and to mortgage or encumber real and personal property of the Trust, without obtaining
consent of any other party(ies).
6. The Trust is: ( ) Irrevocable, ( XX ) Revocable. The following individual(s) has /have power to
revoke the Trust:
JEAN COHEN
7. List all co- trustees below and authority to sign or otherwise authenticate and whether all or
less than all are required in order to exercise powers of the trustee: [If none type or write "None "]
None
8. Title to the property is currently shown in the last deed of record as:
Jean Cohen, Trustee of the Jean Cohen Revocable Trust dated September 28, 1976,
by virtue of that certain deed recorded in O.R. Book 4606, Page 815 of the Public
Records of Collier County, Florida.
That this Affidavit is made for the purpose of inducing Stewart Title Guaranty Company to insure title to
the Property.
Affiant further states that Affiant is familiar with the nature of an oath, and with the penalties as provided
by the laws of the State aforesaid for falsely swearing to statements made in an instrument of this nature.
Sworn to and subscribed before me this&? `o day of
who-T--4) is personally known to me or who ( ) has produced
identification.
My Commission expires:
(SEA TOREY LYN WENDLING
qVNOTARY PUBLIC
STATE OF FLORIDA
- Comm# EE168977
Expires 2113/2016
Je Cohen
, 2012 by JEAN COHEN,
as
Nota u is Signature
Print Name: Lwou
Serial Number