Petition For Protection From Abuse Page 6
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7AFFIDAVIT/VERIFICATION
STATE OF LOUISIANA
PARISH OF
BEFORE ME, the undersigned Notary Public, duly commissioned and qualified in and for the state and
parish aforesaid, personally came and appeared
,
Petitioner in the foregoing Petition for Protection from Abuse, who, after being duly sworn by me, did
depose and say that s/he has read the allegations contained therein and declared them to be true and
correct to the best of her/his knowledge, information, and belief.
Petitioner further said that s/he believes that the defendant poses a threat to petitioner’s safety and/or to
the child(ren) or to others for whom petitioner has requested relief.
Petitioner further said that s/he is aware that any false statement made under oath contained in the
foregoing petition and this affidavit shall constitute perjury and shall be punishable by a fine of not more
than one thousand dollars ($1,000.00), or by imprisonment, with or without hard labor, for not more
than five (5) years, or both.
PETITIONER
SWORN TO AND SUBSCRIBED before me, Notary Public, on the
day of
, 20
, at
, Louisiana.
NOTARY PUBLIC
LPOR B
v.7
Page 6 of 7
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