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GENERAL AFFIDAVIT

State of __________________

County of _________________

Before the undersigned, an officer duly commissioned by the laws of ____________, on this_____day of _____________, 20____, personally appeared ______________________________ who having been first duly sworn depose and say:

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

Witness:________________ _______________________________

Sworn and subscribed before me this ___day of ___________A.D. 20__

__________________________

__________________________

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