AFFIDAVIT OF IDENTITY - INDIVIDUAL

Print Name

State of )
)
)
County of )

Affiant, , being first duly sworn on his/her oath, states

that (s)he is familiar with and acknowledges that (s)he

is one in the same person as , who is also known as

and .

Affiant Signature before Notary Public

This instrument was acknowledged before me on

Date

by .
Name of Person(s)

Signature of notarial officer

My commission expires:

Month, Day, Year

Notary Stamp