State of _______________________________
County of _______________________________
by _______________________________
(Name) _______________________________
(Address) _______________________________
being duly sworn, depose(s) and say(s) that the contents of this (application, etc.) are true to the best of (his or her) knowledge or belief. The undersigned applicant(s) has (have) signed the (application, etc.) this ____________ day of ______________, 19____.
_______________________________
(Applicant(s))
By: _______________________________
Subscribed and sworn to before me, a [Notary Public, or title of other official authorized by the state to notarize documents, as appropriate] of the State of ________________ this day of ______________, 19____.
/SEAL/ [if any]
_______________________________
(Notary Public, or other authorized official)
18 C.F.R. §4.32
For FEDERAL REGISTER citations affecting § 4.32 , see the List of CFR Sections Affected, which appears in the Finding Aids section of the printed volume and at www.govinfo.gov.