THIS IS A SWORN AFFIDAVIT AND MUST BE SIGNED BEFORE A NOTARY
IN THE CIRCUIT COURT OF THE FIFTH JUDICIAL CIRCUIT
IN AND FOR LAKE COUNTY, FLORIDA
CASE NO: _________________________
_______________________________
Petitioner,
VS
_______________________________
Respondent.
AFFIDAVIT
Before me, the undersigned authority, on this day personally appeared
______________________________ who, upon being duly sworn, deposes and says
(List statements in numerical order that Affiant is swearing to)
1.____________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
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I understand that I am swearing or affirming under oath to the truthfulness
of the claims made in this petition and that the punishment for knowingly making
a false statement includes fines and/or imprisonment.
_______________________________
Signature of Petitioner
_____________________
Mailing Address
_______________________________
Telephone _____________________________