Affidavit

City of

In consideration of the terms and covenants of this agreement, and other valuable consideration, the parties agree as follows:

RECITALS

BEFORE ME, the undersigned authority, [NAME AND CAPACITY OF OFFICER BEFORE WHOM AFFIDAVIT IS SWORN], on this [DAY OF MONTH] day of [MONTH], [YEAR], personally appeared Affiant, known to me to be a credible person and of lawful age, who being by me first duly sworn, on [HIS OR HER] oath, deposes and says:

[SET FORTH STATEMENT OF FACTS]

IN WITNESS WHEREOF, the parties hereto have executed this Agreement on the date first above written.