LAWS MOTIONSLINKSTHIS INSTRUMENT HEREBY ACKNOWLEDGES that the undersigned, Lee Allen Martin, ("affiant"), residing at 7050County Road 2810, West Plain, Missouri, is of legal age, and does hereby swear and affirm that the following is true and accurate, to the best of his knowledge, under penalty of perjury:
[list facts to be attested to]
Signed to this [day] day of [month], [year].
_______________________________________
Signature of Affiant
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Print Name of Affiant
_______________________________________
_______________________________________
_______________________________________
Address
STATE OF _____________________
COUNTY OF ____________________
In _______________, on the _____________ day of ____________, 19___, before me, a Notary Public in and for the above state and
county, personally appeared _____________________________________________, known to me or proved to be the person named in
and who executed the foregoing instrument, and being first duly sworn, such person acknowledged that he or she executed said
instrument for the purposes therein contained as his or her free and voluntary act and deed.
Type of ID Produced: _________________________
Affiant __ is __ is not personally known to me
_______________________________
NOTARY PUBLIC
My Commission Expires: ________
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