Affidavit _Alternate Form_

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Affidavit UNITED STATES OF AMERICA STATE OF ) ) ) ) ) ) I, , of the , in the State of , make oath and say as follows: 1. 2. 3. I make this affidavit for no improper purpose. SWORN before me this _____ day of , A Notary Public ) ) ) ) ) ) ) ) ) )

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