IN THE SUPERIOR COURT OF COBB COUNTY STATE OF GEORGIA Plaintiff: vs. Defendant: ____________________ ____________________ ) ) ) ) ) Civil Action File No. _______________ VERIFICATION I, __________________________________, personally appeared before the undersigned Notary Public, and your name say under oath that I am the [check one] that Plaintiff Defendant in the above-styled action and the facts in the ________________________________ are true and correct. Describe Pleading being filed This the____________ day of ___________ , ________. [date] [month] [year] _____________________________________ [Sign your name here in front of a Notary] _____________________________________ Name [Print or Type] _____________________________________ [Address] _____________________________________ [Telephone] Sworn to and subscribed before me, this day of , ________________________________ NOTARY PUBLIC My Commission Expires: [Notary Seal] American LegalNet, Inc. www.FormsWorkflow.com