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Affidavit Before Notary Public


State of [State of affidavit] in the County of [County of affidavit]

Personally appeared before me, [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

Subscribed and sworn to before me on [Date of affidavit]

Notary Public in and for the County of [County of affidavit] in [State of affidavit]