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STATE OF FLORIDA
COUNTY OF County
I, the undersigned, being first duly sworn, do hereby state under oath and under penalty of perjury that the following facts are true:
1. I am over the age of 18 and am 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.
2. I am currently living at: Street address , City , State ZIP Code .
3. Details .
4. Yes / No Details .
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Executed this _____ day of ____________, 20____ in _______________________.__________.
___________________________
Name Jurat / Acknowledgment Myself / Business
| CERTIFICATE OF ACKNOWLEDGMENT |
STATE OF FLORIDA
COUNTY OF ____________________
The foregoing instrument was acknowledged before me this _______________, 20____, by ____________________.
| ________________________________________ | |||||||||||
| NOTARY PUBLIC OR DEPUTY CLERK | |||||||||||
| ________________________________________ | |||||||||||
| Print, type, or stamp commissioned name of notary or clerk |
_______Personally known
_______Produced Identification
| Type of Identification Produced_______________________ |