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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
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Date
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Notary Public
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Title And Rank
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Date Of Commission Expiry
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