Defendant Affidavit Page 2

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Signature:_____________________________________________________________________
Print Name: ___________________________________________________________________
Mailing Address:________________________________________________________________
City, State, Zip:_________________________________________________________________
Subscribed and sworn before me this______day of ____________________, 20_____
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Notary Public/Deputy Court Administrator
My Commission Expires:_________________
DEFENDANT’S AFFIDAVIT - Page 2 of 2
FC (2/22/04)

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