IN THE SUPERIOR COURT OF COBB COUNTY STATE OF GEORGIA Petitioner: ____________________________________ and Civil Action File No.: __________________________ Respondent: __________________________________ VERIFICATION I, _______________________________________, personally appeared before the undersigned attesting officer authorized by law to administer oaths, and after being duly sworn, declare under oath that I am the Petitioner in the above-styled action and that the facts stated in the foregoing Petition for ______________________________ are true and correct to the best of my knowledge. Signed this _________________ day of ________________________________________. [day] [month] [year] _________________________________________________________ (Sign your name here before Notary) Petitioner, Pro se Petitioner’s name (print or type): ______________________________ Petitioner’s Address: ________________________________________ ________________________________________ Petitioner’s Telephone Number: _______________________________ Sworn to and affirmed before me, this _______ day of _________________. ______________________________ NOTARY PUBLIC My commission expires: __________ (Notary Seal) American LegalNet, Inc. www.FormsWorkflow.com