Any affidavit filed for the return of a deposit shall include, but shall not be limited to the following items:

1. (1) Date and location of the accident;

2. (2) Statement that:

   1. (A) One (1) year has elapsed since such deposit was made; and
   2. (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. (3) Signature of the depositor.

Codification Notes: This section as promulgated prior to codification into the Code of Arkansas Rules provided as follows: "1-27-19-618 FORM OF AFFIDAVIT FOR RETURN OF DEPOSIT"