Fillable AFFIDAVIT OF FRAUDULENT USE STATE OF FLORIDA COUNTY (Flagler County Clerk of the Circuit Court & Comptroller)

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AFFIDAVIT OF FRAUDULENT USE STATE OF FLORIDA COUNTY (Flagler County Clerk of the Circuit Court & Comptroller)

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AFFIDAVIT OF FRAUDULENT USE
STATE OF FLORIDA
COUNTY OF FLAGLER CITATION NO.
BEFORE ME, the undersigned authority, personally the undersigned affiant, who being
first duly sworn by me deposes and says that:
1. My full legal name is
2. My resident address is
3. On , , I was charged with the offense of
in Flagler County, State of Florida.
4. I deny that I committed the driving offense for the following reason:
5. Ten examples of my signature are as follows:
6 I HAVE ATTACHED A RECENT PHOTOGRAPH OF MYSELF
7. If known, I have attached the name, address, and relationship of the person I believe to
have committed this driving offense and/or the owner of the vehicle.
8. I request that the Court dismiss the case described in paragraph 3 above and that
suspension (if any) of my driving privileges be lifted.
Signature of Affiant
SWORN TO AND SUBSCRIBED BEFORE ME this Day of
, .
Deputy Clerk / Notary Public
(SEAL) My Commission Expires:
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AFFIDAVIT OF FRAUDULENT USE STATE OF FLORIDA COUNTY (Flagler County Clerk of the Circuit Court & Comptroller)

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Completed 22 July 2021

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