On this, the _______ day of _______, 19____, before me, _________________________, the undersigned officer, personally appeared ____________________, known to me (or satisfactorily proved) to be serving in or with the armed forces of the United States, or who is known to be or has satisfactorily proved that he or she is the dependent of a member, a civilian employee of the armed forces or the dependent of a civilian employee, and who is the person whose name is subscribed to the foregoing _____________ and made oath that he or she knows the contents of the foregoing, and the foregoing is true to the best of his or her knowledge, except as to matters stated to be of information and belief, and as to those matters ____________ he or she ___________ believes them to be true. I am a commissioned officer of the rank stated below, and I am a member of the armed forces of the United States.
______________________________________________ |
Signature of officer |
______________________________________________ |
Rank of officer, and command to which attached |
MCL 600.1440