IN THE SUPERIOR COURT OF ROCKDALE COUNTY
STATE OF GEORGIA
,
Petitioner,
vs.
,
Respondent.
Civil Action Case No:
VERIFICATION
Personally appeared , who, after being duly
sworn, states that the facts alleged in the foregoing
[fill in name of document being
verified] are true and correct.
Sworn to and subscribed before me
this day of
, 20
___
Notary Public
My Commission Expires:
Plaintiff Defendant
[Check one & sign.]