Mandatory Case Disclosure Page 12

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(AA) Signature of person filing
Mandatory Case Disclosure
(BB) Printed name of person filing
Mandatory Case Disclosure
Address
(CC) Telephone Number
DD) COMMONWEALTH OF KENTUCKY
)
)
COUNTY OF _________________)
Subscribed and sworn to before me by the above-named Petitioner/Respondent on this
______ day of ____________________, 20____.
My commission expires: _________________________.
Notary Public
State at Large, Kentucky
12

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