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AFFIDAVIT
STATE OF (1))
ss:
COUNTY OF ____(2))
KNOW ALL YE MEN BY THESE PRESENTS,
That on this _(3)__ day of (4), 19_(5)_, personally came and appeared before me (6), of (7), known, and known to me, who after being first duly sworn, deposes and says:
(Insert Sworn Statement)
FURTHER AFFIANT SAYETH NOT.
(8)
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