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Affidavit Blind Affiant
Subscribed and sworn to before me on __________________, the same having been ________________ (in my presence or by me) read to the affiant, _________ (he or she) being blind, and _________ (he or she) appearing to me to fully understand the same.
Signature and Title
*** If Required By FederaL or State Law ***
This Section for Notary:
State of _________
County of ________ [COUNTY]
On [DATE] before me, [NAME OF NOTARY], notary, personally appeared [NAME OF PERSON(S) INVOLVED], personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
Witness my hand and official seal.
My commission expires: _____