Statement Of Judgment Page 2

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Further, your affiant sayeth not.
Name
___________________________________________
Title
___________________________________________ (if any)
Organization ___________________________________________ (if any)
Address
___________________________________________
___________________________________________
Signed and sworn to before me on the ______ day of _______________________, 20_____ by
____________________________.
____________________________________________
Notary Public
My Commission Expires: ______________________________
AOC Form 27a
Revised 9/05

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