Sworn Statement For Leak/repair Credit (Page 2 of 2) in pdf

Sworn Statement For Leak/repair Credit Page 2

SWORN STATEMENT FOR LEAK/REPAIR CREDIT

AFFIDAVIT

I, ______________________________________, have read or have read to me and understand this statement,

which begins on Page 1, and ends on Page _______. I fully understand the contents of the entire statement

made by me. The statement is true. I have initialed all corrections and have initialed the bottom of each page

containing the statement. I have made this statement freely without hope of benefit or reward, without threat of

punishment, and without coercion, unlawful influence, or unlawful inducement.

____________________________________________________

(Signature of Person Making Statement)

Type of Identification Produced & Verified:

___________________________________________________

Witnesses:

Subscribed and sworn to before me, a person authorized by law

to administer oaths, this

day of

,20___,

____________________________________________________

(Signature of Person Administering Oath/Notary)

____________________________________________________

(Typed Name of Person Administering Oath/Notary)

(Notary Seal)

Initials of Person Making Statement

Page _____ of ____ Pages

Name of Customer Service Representative

Assisting Customer:

Sworn Statement For Leak/repair Credit Page 2