Affidavit Verifying a Claim by pellcity27

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									                              Affidavit Verifying a Claim

STATE OF ____________________
COUNTY OF _______________________

PERSONALLY   appeared before me, the undersigned authority in and for said county
and state, (Name of Affiant), who, having been being first duty sworn by the
undersigned Notary Public, deposes and says:

1.    I am a resident of (street address, city, state, zip code).

2.    I am the claimant in the above-described claim.

3.    I have read the above claim, and the same is true of my own knowledge, except
      as to matter
								
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