Date   I,   First Name   Last Name   of legal age   Age (years old)  , a   Citizenship   citizen, located at   Street Address   Address Line 2   City   State   Zip  , after having been duly sworn to law, do hereby say:
I am executing this affidavit to attest to the truth of the foregoing facts and for whatever legal purpose this may serve.IN WITNESS WHEREOF, I hereby affix my signature this   Date   in Location .Signature   Affiant First Name   Affiant Last Name   Date Signed  Â