GENERAL AFFIDAVIT

State of __________________

County of _________________

Before the undersigned, an officer duly commissioned by
the laws of ____________, on this_____day of _____________,
19____, personally appeared ______________________________
who having been first duly sworn depose and say:
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________

Witness:________________ _______________________________

Sworn and subscribed before me this ___day of ___________
A.D. 19__
__________________________
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