STATE OF [INSERT STATE]
COUNTRY OF [INSERT COUNTRY]
IN THE OF [COURT AND JURISDICTION]
AFFIDAVIT
Case Number:
[INSERT PLAINTIFF] (‘Plaintiff’)
[INSERT DEFENDANT] (‘Defendant’)
I, [INSERT NAME] of [INSERT ADDRESS] do hereby swear under oath that:
1. [INSERT OATH STATEMENT].
2. [INSERT OATH STATEMENT].
3. [INSERT OATH STATEMENT].
Under penalty of perjury, I hereby declare and affirm that the above stated facts, to be the best of
my knowledge, are true and correct.
Dated: [INSERT DATE]
___________________________________
Signature
Printed name:
Date:
NOTARY OF ACKNOWLEDGEMENT
State of: [INSERT STATE]
Country of: [INSERT COUNTRY] (Seal)
This Affidavit was acknowledged on the [INSERT DATE] by the undersigned, [INSERT UNDERSIGNED
NAME], who has satisfactorily proven to me to be the person whose name is subscribed to this
document.
___________________________________
Signature
___________________________________
Notary Public
My Commission Expires on the: ___________________________________