(1) The form and content of the affidavit exempting property from withholding tax liens shall be approved by the department and shall contain as much as available of the following information:

(a) the name, address, telephone number and signature of the grantor. The signature of the grantor must be dated and properly witnessed or notarized.

(b) the name and address of the third party acquiring an interest in the real or personal property identified.

(c) the complete identity of the property to be affected by the affidavit, to include as applicable:

(i) make;

(ii) model;

(iii) serial or identification number; and

(iv) legal description.

(d) a statement or certification that all taxes, assessments, penalties and interest due from the grantor under 15-30-201 through 15-30-209 , MCA, have been paid.