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State of California
County of Yes / No County
I, the undersigned, do hereby swear, certify, and affirm that:
1. I am over the age of 18 and a resident of the state of State . I have personal knowledge of the facts in this affidavit, and, if called as a witness, could testify competently about them.Jurat / Acknowledgment
2. I am currently living at: Street address , City , State ZIP Code .
3. Details .
4. Yes / No Details .
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100. Yes / No Details .
I declare under penalty of perjury under the laws of the state of California that the foregoing is true and correct.
| Date:_______________________________ | ____________________________________________ Name |
| ACKKNOWLEDGMENT |
| A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. |
State of California
County of Signing County
On ______________________________ before me __________________________ personally appeared __________________________ , who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity on behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the state of California that the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
| ________________________________________(Notary Seal) Signature of Notary Public |
| ________________________________________ Printed Name |
| My Commission expires: ______________ |