Affidavit And Acknowledgement Of Debt And Conditional Release Of Liability Page 2

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FURTHER AFFIANTS SAYETH NOT.
_______________________________________________________________(Seal)
Affiant
_______________________________________________________________(Seal)
Affiant
Sworn to and described before me this ______ day of _______________, 20____.
____________________________________ _____________________________________
Witness
Notary Public
(Seal)

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