Affidavit
STATE OF ________________
COUNTY OF _______________
I, ____________________ (the "Affiant"), residing at ____________________________________, do hereby swear or affirm under penalty of perjury that the following statements are true and accurate to the best of my knowledge:
- My legal name is ____________________________________, and I am a citizen/permanent resident of __________, born on ____________________.
- I am competent to testify if called into court as a witness regarding the matters discussed in this affidavit.
- The facts stated in this affidavit are based on my personal knowledge.
- [Specific fact(s) or statement(s) needing verification]
I understand that these statements are made under the penalties of perjury and that false statements herein are made subject to the penalties of state law.
Further Affiant sayeth naught.
IN WITNESS WHEREOF, I have hereunto set my hand and seal on this ____ day of __________, 20__.
________________________________
Signature of Affiant
________________________________
Printed Name of Affiant
Subscribed and sworn to (or affirmed) before me on this ____ day of __________, 20__, by ____________________, proved to me on the basis of satisfactory evidence to be the person who appeared before me.
________________________________
Notary Public
My commission expires: __________