AFFIDAVIT OF FRAUDULENT USE STATE OF FLORIDA COUNTY OF ALACHUA CASE NO.__________________________ BEFORE ME, the undersigned authority, personally the undersigned affiant, who being first duly sworn by me deposes and says that: 1. My full legal name is __________________________________________________________________ 2. My resident address is _________________________________________________ ________________ 3. On ____________________, _________, I was charged with the offense of __ ____________________ in Alachua County, State of Florida. 4. I deny that I committed the driving offense for the following reason: 5. Ten examples of my signature are as follows: __________________________________ __________________________________________ __________________________________ __________________________________________ __________________________________ __________________________________________ __________________________________ __________________________________________ __________________________________ __________________________________________ 6 I HAVE ATTACHED A RECENT PHOTOGRAPH OF MYSELF 7. If known, I have attached the name, address, and relationship of the person I believe to have committed this driving offense and/or the owner of the vehicle. 8. I request that the Court dismiss the case described in paragraph 3 above and that suspension (if any) of my driving privileges be lifted. __________________________________________ Signature of Affiant SWORN TO AND SUBSCRIBED BEFORE ME this ______ Day of ___________________ __, _________. __________________________________________ D eputy Clerk / Notary Public (SEAL) My Commission Expires: ___________________