Affidavit

I,  Full Name of Person Making Sworn Statement of Address of Person Making Sworn Statement, being of legal age, do hereby depose and say under oath as follows:

1.                  I am a resident of State Jurisdiction of Residency (ie. the State of California, United States of America).

2.                  I make this Affidavit for no improper purpose.

Witness my hand under the penalties of perjury Date of Statement (ie. July 1, 2000)

STATE OF STATE

COUNTY OF COUNTY

On Date of Statement (ie. July 1, 2007) before me, Full Name of Notary Taking Sworn Statement, personally appeared Full Name of Person Making Sworn Statement, personally known to me (or proved to me on the basis of satisfactory evidence) to be the person whose name is subscribed to the within instrument and acknowledged to me that  executed the same in  authorized capacity, and that by  signature on the instrument the person executed the instrument.

WITNESS my hand and official seal.

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