Affidavit
State of ${input_8_45} , County of ${input_8_46}
My current legal name is ${input_8_10_3} and my current occupation is ${input_8_31} . I am presently ${input_8_29} years old, and my current address of residence is ${input_8_20_1} , ${input_8_20_3} , ${input_8_20_4} ${input_8_20_5} .
${field_8_37}
I hereby state that the information above is true, to the best of my knowledge. I also confirm that the information here is both accurate and complete, and relevant information has not been omitted.
Signature of Individual
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Date
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Notary Public
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Title And Rank
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Date of Commission Expiry
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