Comment [Note1]: General form of

Affidavit Affidavit to be used when one person

wishes to make a sworn statement in the
presence of a Notary Public. Statement by
Notary Public.
I, Full Name of Person Making Sworn Statement of Address of Person Making Sworn NB: The Notary Public must witness the
Statement, being of legal age, do hereby depose and say under oath as follows: signature and sign and seal the
document.

1. Insert List of Statements Being Sworn

2.

3.

Witness my hand under the penalties of perjury Date of Statement (ie. July 1, 2000)

Signature Of Deponent

STATE OF STATE
COUNTY OF COUNTY

On Date of Statement (ie. July 1, 2000) before me, Full Name of Notary Taking Sworn Statement,
personally appeared Full Name of Person Making Sworn Statement, personally known to me (or proved
to me on the basis of satisfactory evidence) to be the person whose name is subscribed to the within
instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his
signature on the instrument the person executed the instrument.

WITNESS my hand and official seal.

Signature