IN THE COUNTY COURT OF THE SIXTH JUDICUAL CIRCUIT
IN AND FOR PINELLAS COUNTY, FLORIDA
Case No. ___________________________
Plaintiff(s)
-vs-
Defendant(s)
AFFIDAVIT AS TO MILITARY STATUS
I, {full legal name} ________________________________, being sworn, certify that the following
information is true:
[√ all that apply]
_____ 1. I know of my own personal knowledge that Defendant(s) is not on active duty in the armed services
of the United States .
_____ 2. I have inquired of the armed services of the United States and the U.S. Public Health Service to
determine whether the Defendant(s) is a member of the armed services and am attaching certificates
stating that Defendant(s) is not now in the armed services.
I understand that I am swearing or affirming under oath to the truthfulness of the claims
made in this affidavit and that the punishment for knowingly making a false statement includes fines
and/or imprisonment.
Signature of Plaintiff(s)
Print Name: _____________________________
Address: ________________________________
City, State, Zip: __________________________
Telephone No: ___________________________
STATE OF FLORIDA
COUNTY OF PINELLAS
Sworn to or affirmed and signed before me on __________ by _____________________________________.
NOTARY PUBLIC or DEPUTY CLERK
___________________________________________________
[Print, type, or stamp commissioned name of notary or clerk.]
_____ Personally known
_____ Produced identification
Type of identification produced ___________________________
