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Back to Forms for 'Affidavits'.





On _________________________ (date), 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 as the case may be) and to be the person whose name is subscribed to the within instrument, and acknowledged that __________ (he or she) executed the same; and the undersigned certifies that _____________ (he or she) is at the time of this certificate was executed a commissioned officer of the rank stated below, and is in the active service of the armed forces of the United States.



____________________________                         _________________

Signature and Rank                                                    Dated 






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