Affidavit

State of , County of

My current legal name is , and my current occupation is . I am presently years old, and my current address of residence is , , .

.

I hereby state that the information above is true, to the best of my knowledge. I also confirm that the information here is both accurate and complete, and relevant information has not been omitted.

Signature of Individual

_________________________________

Date

_________________________________

 

 

Notary Public

_______________________

Title And Rank

_______________________

Date Of Commission Expiry

_______________________