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
_______________________