Mary Louise Nicholson, County Clerk
Affidavit of Age and Identity
Colorado
THE STATE OF __________________
weld
COUNTY OF ____________________
Oscar Spencer Ramirez
Before me, the undersigned authority, on this day personally appeared __________________________
Oscar Spencer Ramirez / FILE NO. : 165673-1964
, known to me to be the person
(name of applicant)
09/21/1964
who subscribed their name below, and have verified their date of birth is _________________________ .
(MM/DD/YYYY)
Signature of Applicant
Oscar Spencer Ramirez
Print Full Legal Name of Affiant as shown on identification provided
Subscribed and sworn to before me on this day of , 20 .
(Signature of Notary Public)
Seal