_______________________________________________________________________________________________________________________ I, the applicant, am fully aware that this application is a government document and, under penalties of perjury I declare the foregoing information to be true and correct. Name (Type or Print) Signature Applicant’s Applicant’s Sworn to and subscribed before me, this the day of Name of Notary (Print or Type) SEAL OR STAMP ____________________ ______________________________________ My Commission Expires Signature of Notary
_______________________________________________________________________________________________________________________ I, the applicant, am fully aware that this application is a government document and, under penalties of perjury I declare the foregoing information to be true and correct. Applicant’s Name (Type or Print) Applicant’s Signature Sworn to and subscribed before me, this the day of Name of Notary (Print or Type) SEAL OR STAMP ____________________ My Commission Expires ______________________________________ Signature of Notary