Pennsylvania General Affidavit

Pennsylvania General Affidavit

GENERAL AFFIDAVIT

Commonwealth of Pennsylvania
County of ________________

BEFORE ME, the undersigned Notary, ___________________________________________________  [name of Notary before whom affidavit is sworn], on this _________________  [day of month] day of _________________  [month], 20____, personally appeared ___________________________________________________  [name of affiant], known to me to be a credible person and of lawful age, who being by me first duly sworn, on ________  [his or her] oath, deposes and says:

___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
[set forth affiant's statement of facts]

__________________________________ 
[signature of affiant]

__________________________________ 
[typed name of affiant]

__________________________________ 
[address of affiant, line 1]

__________________________________ 
[address of affiant, line 2]

Commonwealth of Pennsylvania
County of ________________

On this, the _____ day of _________________, 20____, before me ________________________________________, the undersigned officer, personally appeared
_____________________________________________________________________________, known to me (or satisfactorily proven) to be the person(s) whose name(s) is/are subscribed to the within instrument, and acknowledged that __________________________________ executed the same for the purposes therein contained.

In witness whereof, I hereunto set my hand and official seals.


___________________________________


___________________________________
Title of Officer

---