Declaration Under the Penalty of Perjury, Notary Statement

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Declaration Under the Penalty of Perjury, Notary Statement

STATE OF ___________________

COUNTY OF __________________

_______________________, herewith declares under the penalties of perjury:

That they are competent under the law to give this declaration and unless stated have personal knowledge of the facts stated herein:

____________________________________

Notary

Expiration Expires