Verification

IN THE SUPERIOR COURT OF FULTON COUNTY STATE OF GEORGIA FAMILY DIVISION Petitioner: and Respondent: Civil Action File No: VERIFICATION I, _________________________, personally appeared before the undersigned Notary Public, and say under oath that I am the (check one:) " Petitioner " Respondent in the above-styled action and that the facts stated in the are true and correct. This the ____________________ day of _____________________, _____. [date] [month] [year] __________________________________________________ (Sign your name here in front of the Notary) Name (print or type):___________________________________ Address:____________________________________________ ___________________________________________________ Telephone number: ( ) Sworn to and subscribed before me, this _____ day of _________________, _______. NOTARY PUBLIC My Commission Expires: (Notary Seal) If you require materials in alternate format, please notify the Family Law Information Center as soon as possible. Verification Form-rev. 9/99 Page 1 of 1 2000 © American LegalNet, Inc.