STATE OF ILLINOIS
COUNTY OF
I, the undersigned, being duly sworn, do hereby depose and say:
1. I am over the age of 18 and am a resident of the state of . I have personal knowledge of the facts in this affidavit, and, if called as a witness, could testify competently about them.
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Under penalties as provided by Illinois law, the undersigned certifies that the statements set forth in this instrument are true and correct.
Executed this _____ day of ____________, 20____ in _______________________.__________.
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CERTIFICATE OF ACKNOWLEDGMENTJURAT |
STATE OF ILLINOIS
COUNTY OF ____________________
This instrument was acknowledged before me on _________________, 20____, by .This instrument was acknowledged before me on _____________________, 20____, by as _________________________________________ of .Signed and sworn (or affirmed) to before me on ____________, 20___, by .
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(Notary Seal) | | | | | | | | | | | ________________________________________ |
| | | | | | | | | | | Signature of Notary Public |
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| | | | | | | | | | | ________________________________________ |
| | | | | | | | | | | Printed Name |
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| | | | | | | | | | | My Commission expires: ______________ |