1112.9 Sample verification for statement of fact under modified procedure.
§ 1112.9 Sample verification for statement of fact under modified
procedure. State of __________, County of __________, SS:
__________ being duly sworn, deposes and says that he has read the
foregoing statement, knows the facts asserted there are true and
that the same are true as stated. Signed __________. Subscribed and
sworn to before me this _____ day of __________. Notary Public of
__________. My Commission expires __________.