AFFIDAVIT Florida Statutes 117.05(5)(b)(2) (Affidavit to enable notary to notarize signature of party based upon credible witness whose identity is proven to the notary where such witness personally knows the party whose signature is to be notarized) Before me, the undersigned authority, personally appeared the undersigned party who has executed this Affidavit, who made the following statements: Purpose of Affidavit. I am making this Affidavit for the purpose of enabling , notary public for the State of (2) , (the "Notary") to notarize the signature of (the "Executing Party"). 2. Statements Made from Personal Knowledge. A. B. "Documents"): I personally know the Executing Party. The Executing Party is the person named in the following documents (the 1. C. I reasonably believe that the circumstances of the Executing Party are such that it would be very difficult or impossible for the Executing Party to obtain another form of identification. D. documents: (i) an identification card or driver's license issued by the Department of Highway Safety and Motor Vehicles; (ii) a passport issued by the Department of State of the United States; or The Executing Party does not possess any of the following identifying (iii) one of the following forms of identification, if the document is current or has been issued within the past 5 years and bears a serial or other identifying number, and, if the document is a passport, the document is stamped by the United States Immigration and Naturalization Service: (a) a passport issued by a foreign government; BAR FORM NO. R-4.12 © Florida Lawyers Support Services, Inc. 2008 (b) a driver's license issued by a territory of the United States or a state other than Florida or by a Canadian or Mexican public agency authorized to issue drivers' licenses; (c) state other than Florida; (d) the United States; (e) an inmate identification card issued on or after January 1, 1991, by the Department of Corrections for an inmate who is in the custody of the department; or (f) an identification card issued by the United States Department of Justice, Immigration, and Naturalization Service. E. I do not have a financial interest in nor am I a party to the underlying transaction as contemplated by the Documents. Appropriate Signature Jurat Comment: When notary is relying on sworn statement pursuant to the cited Statute, notary must secure sworn statements from two credible witnesses. an identification card issued by a territory of the United States or a an identification card issued by any branch of the armed forces of BAR FORM NO. R-4.12 © Florida Lawyers Support Services, Inc. 2008