STATEMENT OF FACTS GIVEN BY
Here set out the body of the factual statement
B.G., first being duly sworn on his/her oath, states that he/she is the (president or
other designated and authorized officer) of ABC, Inc., a corporation organized under the
laws of the State of _____________, and verifies that the statement of facts, as set out
above, are true to the best of his/her knowledge and belief.
(Corporate Seal) By: __________________________
(president or authorized officer)