THIS IS A SWORN AFFIDAVIT AND MUST BE SIGNED BEFORE A NOTARY IN THE CIRCUIT COURT OF THE FIFTH JUDICIAL CIRCUIT IN AND FOR LAKE COUNTY, FLORIDA CASE NO: Petitioner, VS Respondent. AFFIDAVIT Before me, the undersigned authority, on this day personally appeared who, upon being duly sworn, deposes and says (List statements in numerical order that Affiant is swearing to) 1. I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this petition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Signature of Petitioner Mailing Address Telephone American LegalNet, Inc. www.FormsWorkFlow.com STATE OF FLORIDA COUNTY OF LAKE The instrument was acknowledged before me on this day of , 20, by . Personally Known Produced Identification NOTARY PUBLIC/DEPUTY CLERK Drivers License No. Print, type, or stamp commissioned name of notary or deputy clerk. I have mailed a copy to: (the other party) MUST HAVE THE NAME AND CURRENT ADDRESS THE ORIGINAL OF THIS DOCUMENT MUST BE FILED WITH: American LegalNet, Inc. www.FormsWorkFlow.com W T 32778