With the Armed Forces | ) | ||||||
of the United States | ) ss | ||||||
at ______ | ) | ||||||
(Body of instrument) | |||||||
Subscribed and sworn to (affirmed) by ______, to me known to be a member of the Armed Forces of the United States, on active duty therewith, before me, a commissioned officer of the Armed Forces of the United States, on active duty therewith, this ______ day of ______, A.D. 20______. | |||||||
(Signature) | (Serial Number) | ||||||
______________________________________________________ | |||||||
(Grade) | (Branch of service: | Army, Navy, etc.) | |||||
______________________________________________________ | |||||||
(Permanent mailing address) | |||||||
______________________________________________________ |
§ 492.070, RSMo
Effective 6/12/1991