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 
_______________________