Sample Affidavit Form Page 3

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File no._______ 
 
 
 
 
 
 
 
 
 
 
City of _____Registry 
 
          
IN THE SUPREME COURT OF _____PROVINCE/STATE______ 
  
 
YOUR NAME
BETWEEN: 
 
 
        
 
                                                                                                                                                               PETITIONER 
HUSBAND’S NAME
AND:                                                     
 
                                                          
RESPONDENT    
 
                 
                                
________________________________________________________________________      
AFFIDAVIT OF ____YOUR NAME___________ 
________________________________________________________________________  
           
 
 
(this is the back page which gets attached with the print on the ‘outside’.  If you turn the whole 
document over this will be visible) 
 

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