In the District Court of _______________ County State of Oklahoma ______________________________ } Plaintiff, } } v. } } ______________________________ } ______________________________ } } ______________________________ } Defendant(s) } Case No. _______________________ (To be entered by Court Clerk) Affidavit On the ________ day of _____________________, 20_____, I, _________________________, of lawful age, being duly sworn, state as follows, that, in the past ten (10) years I have filed the following lawsuits in any State or Federal court, with the outcomes also listed below: Court Case Style Outcome / Disposition I declare, under penalty of perjury, that I have examined all statements contained herein, and to the best of my knowledge and belief, they are true, correct and complete. ____________________________________ Signature Subscribed and sworn to this _________ day of ________________________, 20_____. ____________________________________ Notary Public ( Seal ) My Commission Expires: ____________________________ AOC Form 7a Revised 9/05 American LegalNet, Inc. www.USCourtForms.com