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STATE OF ______(1)_______)

ss:

COUNTY OF ____(2)________)

KNOW ALL YE MEN BY THESE PRESENTS,

That on this _(3)__ day of ______(4)_________, 19_(5)_, personally came and appeared before me ______(6)__________, of __________(7)_______________, known, and known to me, who after being first duly sworn, deposes and says:

(Insert Sworn Statement)

FURTHER AFFIANT SAYETH NOT.

__________(8)____________

SUBSCRIBED TO AND SWORN TO before me this ___(9) day of____(10)____________, 19_(11)_.

_____________(12)__________

NOTARY PUBLIC

My Commission Expires __(13)__

The information in this document is designed to provide an outline that you can follow when formulating business or personal plans. Due to the variances of many local, city, county and state laws, we recommend that you seek professional legal counseling before entering into any contract or agreement.