AFVOA Newletters of Year 2003

Page 27 of 170 Certified that the above statement was declared before me at PLACE on this _________ day of MONTH, YEAR by DEPONENT’S NAME, RELATION WITH EX-SERVICEMAN/EX- SERVICEWOMAN, ARMY NO, RANK, NAME, of REGIMENT’S NAME who is identified by NAME, S/O (FATHER’S NAME OF IDENTIFIER) and witnessed by NAME, S/O (FATHER’S NAME OF WITNESS ) & NAME, S/O (FATHER’S NAME OF WITNESS). Identified by Signature (NAME IN BLOCK CAPITALS) (FULL POSTAL ADDRESS) WITNESS Signature 1. (NAME IN BLOCK CAPITALS) (FULL POSTAL ADDRESS) Signature 2. (NAME IN BLOCK CAPITALS) (FULL POSTAL ADDRESS) ATTESTED BY MAGISTRATE