AFFIDAVIT

I, [your name], do under pledge depose and say:

I am above the age of eighteen years.
– [Body of Statement] –
I confirm that the information mentioned above is to be true to the best of my knowledge and belief.
IN WITNESS WHEREOF, and under perjury punishment, under the State of [state name] laws, I
affix my hand this [day name] day of [month name], [year].
__________________________________________________
[Full Name]
[State name], [County name] County –

I, __________________________________, hereby confirm that on this ______ day of

________, __________, appeared before me in person.
____________________________________________________________,
identified to be the person(s) who executed the previous instrument.
__________________________________________
Notary Public in and for the State of _________________.
My commission expires _______________.