AFFIDAVIT OF IDENTITY (NAME VARIATION)

I, __________, born on __________, resident of __________, do hereby solemnly affirm and declare as under:

1. 1. That my name appears as follows in the documents stated:

1. 5. That the contents of this affidavit are true and correct to my knowledge and belief, that no part of it is false and that nothing material has been concealed therefrom.

VERIFICATION

DEPONENT

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