Affidavit Attesting to the Mailing of Papers or Documents

STATE OF ____________________
COUNTY OF _______________________

PERSONALLY appeared before me, the undersigned authority in and for said county
and
state, _______________________________, who, having been being first duty sworn by the
undersigned Notary Public, deposes and says:

The undersigned Affiant is over the age of eighteen (18), and, on

_______________________________ (day, month, year), I mailed
_______________________ (describe the paper or document mailed), a copy of which is
attached to this Affidavit and marked Exhibit A, to the addressee set forth below, by depositing
_______________________________ (describe the paper or document mailed) enclosed in a
postpaid wrapper, in an official depository under the exclusive care and custody of the United
States Postal Service, in ___________________ _____________________________________
(city, county, state), addressed as follows:
_____________________________________________________________________________
_______________________________ (name and address of addressee).

(Any Further Statement of Facts by Affiant)

SWORN to and subscribed before me, this the ____ day of _____________, 20____.

____________________
NOTARY PUBLIC

My Commission Expires:

_______________________

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