27 CAR § 30-172. Form of affidavit for return of deposit

Any affidavit filed for the return of a deposit shall include, but shall not be limited to the following items: (1) Date and location of the accident; (2) Statement that: (A) One (1) year has elapsed since such deposit was made; and (B) During such period no action at law has been instituted and is pending as a result of the accident against any person on whose behalf the deposit was made, nor has any judgment been rendered which remains unsatisfied; and (3) Signature of the depositor.