Superior Court of Washington
County of Jefferson
_________________________________, No. ___________________________________
Plaintiff/Petitioner
FACSIMILE AFFIDAVIT
vs.
(AF)
_________________________________,
Defendant/Respondent
I, _____________________________________(name), ______________________________ (title), with
___________________________________________ (firm/organization), declare and state the following:
The attached is a facsimile transmission of __________________________________________________
____________________________________________________________________ (titles of documents)
submitted by_________________________________(name), ______________________________ (title),
in the above-entitled matter.
The attached document(s), prepared for filing on the ________ day of ____________________, 20______,
and consisting of ______________ pages, including this affidavit page, has been examined and
determined by me to be complete and legible.
DATED: ___________________________ SIGNED: __________________________________
Address: __________________________________
__________________________________
Phone: __________________________________
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