This Is A Sworn Affidavit And Must Be Signed Before A Notary Page 2

STATE OF FLORIDA

COUNTY OF LAKE

The instrument was acknowledged before me on this _____ day of _______________,

20_____, by ________________________________ .

______ Personally Known

_______________________________

______ Produced Identification

NOTARY PUBLIC/DEPUTY CLERK

______ Drivers License No._____________________

_______________________________

Print, type, or stamp commissioned

name of notary or deputy clerk.

I have mailed a copy to:

(the other party)

MUST HAVE THE NAME AND CURRENT ADDRESS

________________________________

THE ORIGINAL OF THIS DOCUMENT MUST BE FILED WITH:

NEIL KELLY, CLERK

JUDICIAL BUILDING, THIRD FLOOR

550 WEST MAIN STREET

TAVARES, FLORIDA 32778

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Parent category: Legal