Appendix IV to Part 1201 - Sample Declaration Under 28 U.S.C.1746

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Appendix IV to Part 1201 - Sample Declaration Under 28 U.S.C.1746

Declaration

I, ___________, do hereby declare:

I declare under penalty of perjury under the laws of the United States of America that the foregoing is true and correct.

Executed on

Date

Signature

                    
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