<< Matter.CustomField.

DistrictCourtName >>
<< Matter.CustomField.ParishOfDistrictCourt >>
STATE OF LOUISIANA

NUMBER: DIVISION:

<< Matter.Client.Name >>

VERSUS

<< Matter.CustomField.NameOpposingParty >>

Filed:________________________ Deputy Clerk_______________________

VERIFICATION

PARISH OF ST. TAMMANY

STATE OF LOUISIANA

BEFORE ME, the undersigned authority, personally came and appeared <<

Matter.Client.Name >> , who, after being first duly sworn by me did depose and say that affiant

has read all of the allegations contained in the foregoing petition and that they are true and

correct to the best of affiant’s knowledge, information and belief.

__________________________________
<< Matter.Client.Name >>

SWORN TO AND SUBSCRIBED

before me, on this __ day of ________, 20_

__________________________________

NOTARY PUBLIC, No.:________________

Printed Name: _________________________

My Commission Expires: ________________