AFFIDAVIT

STATE OF _____________
			ss:  
COUNTY OF ____________

KNOW ALL YE MEN BY THESE PRESENTS,

That on this ___ day of _______________, 20__, personally came and appeared before me ________________, of _________________________, known, and known to me, who 
after being first duly sworn, deposes and says:



FURTHER AFFIANT SAYETH NOT.

                                        ______________________

SUBSCRIBED TO AND SWORN TO before me this ___ day of________________, 20__.

                                       _______________________
                                                    NOTARY PUBLIC
                                   
	My Commission Expires ____