Affidavit of Residency

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AFFIDAVIT OF RESIDENCY

The State of Ohio

County of ____________________

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) S.S.
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I, ____________________, make oath and under penalty of perjury, say:

I am of legal age, mentally competent, and fully understand the contents and implications of this Affidavit.
I am a resident at _______________________________________, ____________________, in the State of Ohio (the "Residence").
I have resided at this address since ___________, and in the State of Ohio for ___________________
The Residence is a house.
I am making this Affidavit for the purpose of _______________________________________________________________________
_______________________________________________________________________

I declare under penalty of perjury that the foregoing is true and correct to the best of my knowledge and belief.

STATE OF OHIO COUNTY OF ____________________ SUBSCRIBED AND SWORN TO BEFORE ME, on the ________ day of ________________, ________ Signature _____________________________ (Seal) NOTARY PUBLIC My Commission expires: ______________________			_______________________________ (Signature) ____________________

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