STATE OF TEXAS
COUNTY OF
1. I am over the age of 18 and am a resident of the state of
2. I am currently living at:
3.
Executed this _____ day of __________________, 20____ in _______________________.____________________.
__________________________________________
STATE OF TEXAS
COUNTY OF _____________________
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Notary Public in and for the State of Texas |
My Commission expires: ______________ |