Affidavit of Truth: Plain Statement of Facts

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AFFIDAVIT OF TRUTH

13 June 2014

The undersigned Affiant, john henry of the family Doe, hereinafter “Affiant”, does solemnly swear,
declare and state as follows:

1. Affiant is competent to state the matters set forth herein.

2. Affiant has knowledge of the facts stated herein.

3. All the facts herein are true, correct and complete, admissible as evidence and if called upon
as a witness, Affiant will testify to their veracity.

Plain Statement of Facts

4. I swear and affirm that on X month, # day, 2014…..this happened.

5. I swear and affirm that on X month, # day, 2014…..this happened.

6. I swear and affirm that on X month, # day, 2014…..this happened.

7. I swear and affirm that on X month, # day, 2014…..this happened.

8. I swear and affirm that on X month, # day, 2014…..this happened.

Failure to respond or rebut within twenty-one (21) days shall convey your assent to, and
agreement with all the facts herein.

IN WITNESS WHEREOF I hereunto set my hand and seal on this ___________ day of May, 2014
and hereby certify all the statements made above are true, correct and complete under the
penalty of perjury in the laws of the united States of America.

By: _______________________________________________________
John henry of the family Doe

JURAT
State of YOURSTATE )
) ss.
County of YOURCOUNTY )

Sworn to (or affirmed) and subscribed before me on this _______ day of ______________ 2014 by john henry of
the family doe, proved to me on the basis of satisfactory evidence to be the one who appeared before me, and
executed the forgoing instrument for the purpose stated therein and acknowledged that said execution was by
his free act and deed.

_______________________________ ______________________________
Notary Public’s Signature Date

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