IN THE SUPERIOR COURT OF DEKALB COUNTY STATE OF GEORGIA Petitioner: _________________________ And Respondent : ________________________ Civil Action File No: ____________ VERIFICATION Personally appeared _____________________________, the Petitioner, who after being duly sworn, states that the facts alleged in the foregoing Petition for Modification of Child Support are true and correct to the best of the Petitioner's knowledge. __________________________________________ (Sign your name here in front of the Notary) Pro Se Petitioner's name (print or type) ________________ Petitioner's address: _________________________ __________________________________________ Petitioner's telephone number: _________________ Sworn to and affirm before me, this _____ day of _________, _______. ____________________________ NOTARY PUBLIC My Commission Expires: (Notary Seal) American LegalNet, Inc. www.FormsWorkFlow.com