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Affidavit Before A County Officer
AFFIDAVIT BEFORE A COUNTY OFFICER
State of [State of affidavit] in the County of [County of affidavit]
Personally appeared before me, [title of officer] in and for the above-mentioned county, [Name of affiant], who, being duly sworn according to law, deposes and says:
a. [statement of fact 1]
b. [statement of fact 2]
Signature Dated
Sworn to before me and signed in my presence on [Date signed].
Signature Dated
[Title of officer] of the County of
in the State of .
(Seal)