Case 1:04-cv-01250-SLR
Document 20
Filed 09/29/2005
Page 1 of 4
AFFIDAVIT
the undersigned
and belief, and as to those I believe them to be true. Witness my hand under the penalties of perjury this
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28 * of day
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9065
Name
I
Address
COUNTY OF "''r; , personally appeared , personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) islare subscribed to the within instrument and acknowledged to me that helshelthey executed the same in hisherltheir authorized capacity(ies), and that by hisherltheir signature(s) on the instrument the person(s), or the entity upon behalf nf which the pers WITNESS my hand and nt'ficial seal.
On
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y-
before me,
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Case 1:04-cv-01250-SLR
Document 20
Filed 09/29/2005
Page 2 of 4
Case 1:04-cv-01250-SLR
Document 20
Filed 09/29/2005
Page 3 of 4
Case 1:04-cv-01250-SLR
Document 20
Filed 09/29/2005
Page 4 of 4