Illinois General Affidavit
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
2. I am currently living at:
3.
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 _______________________.__________.
___________________________
STATE OF ILLINOIS
COUNTY OF ____________________
(Notary Seal) | ________________________________________ | ||||||||||
Signature of Notary Public | |||||||||||
________________________________________ | |||||||||||
Printed Name | |||||||||||
My Commission expires: ______________ |
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