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STATE OF ILLINOIS
COUNTY OF County
I, the undersigned, being duly sworn, do hereby depose and say:
1. I am over the age of 18 and am a resident of the state of State . I have personal knowledge of the facts in this affidavit, and, if called as a witness, could testify competently about them.
2. I am currently living at: Street address , City , State ZIP Code .
3. Details .
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Under penalties as provided by Illinois law, the undersigned certifies that the statements set forth in this instrument are true and correct.
Executed this _____ day of ____________, 20____ in _______________________.__________.
___________________________
Name Jurat / Acknowledgement Myself / Business
| CERTIFICATE OF ACKNOWLEDGMENT |
STATE OF ILLINOIS
COUNTY OF ____________________
This instrument was acknowledged before me on _________________, 20____, by Cust Name .
| (Notary Seal) | ________________________________________ | ||||||||||
| Signature of Notary Public | |||||||||||
| ________________________________________ | |||||||||||
| Printed Name | |||||||||||
| My Commission expires: ______________ |