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The within named person (Affiant), ______________________________, who is a resident of
____________________ County, State of ____________________, personally came and appeared
before me, the undersigned Notary Public, and makes this his/her statement, testimony and General
Affidavit under oath or affirmation, in good faith, and under penalty of perjury, of sincere belief and
personal knowledge that the following matters, facts, and things set forth are true and correct, to the best
of his/her knowledge:
Dated this __________ day of ____________________ , 20______,
Signature of Affiant
State of ____________________
County of ____________________
Subscribed and sworn to, or affirmed, before me on this __________ day of ____________________,
20______ by Affiant ______________________________.
Signature of Notary Public
My Commission Expires:
General Affidavit
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