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
_______________________