Blank Affidavit of Statement

I. Personal Information

I, [Your Name], of legal age, residing at [Your Address], do hereby affirm and state the following:

II. Identification

Full Name: [Your Name]
Date of Birth: [Date of Birth]
Social Security Number: [SSN]
Current Address: [Address]
Contact Information: [Phone Number], [Your Email]

III. Statement of Facts

On [Date], I [describe the events or transactions you witnessed or were involved in].
[Provide a detailed and chronological narration of the facts, including relevant dates, locations, and names of involved parties].
I have attached supporting documents as evidence, including [list of attached documents].

IV. Oath and Signature

I hereby swear and affirm under the penalties of perjury that the foregoing statements are true and correct to the best of my knowledge and belief.

Signed on this [Day] day of [Month], [Year].

[Your Name]

V. Notary Acknowledgment

State of [State], County of [County]

Subscribed and sworn to (or affirmed) before me on this [Day] day of [Month], [Year], by [Your Name], personally known to me or proved to me on the basis of satisfactory evidence to be the person who appeared before me.

[Notary Printed Name]
Notary Public, State of [State]
My Commission Expires: [Date]

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