STATE OF
COUNTY OF
PERSONALLY came and appeared before me, the undersigned Notary, the within named ___________________________, who is a resident of _________________________ country, State of ___________________________, and makes this his/her statement and General Affidavit upon oath and affirmation of belief and personal knowledge that the following matter, facts and things set forth are true and correct to the best of his/her knowledge: (Insert Statement)
DATED this the ____day of ____________________________,20____________ ______________________ signature of affidavit SWORN to subscribed before me, this __________ day ____ __________ , 20______________ _________________ NOTARY PUBLIC