STATE OF TEXAS
COUNTY OF HAYS
BEFORE ME, the undersigned authority, this day personally appeared ________________________,
who being by me duly sworn, on oath as follows: My name is ________________________, I am of
sound mind, capable of making this affidavit and personally acquainted with the facts herein stated.
I am the owner representative of: Business Name:________________________________________
City, State, Zip: ___________________________________________________________________
On ______________, I sent notice in writing via First Class Mail to the accused.
Name letter sent:_____________________________________________
Address letter sent:___________________________________________
City, State, Zip: _____________________________________________
Subscribed and Sworn to before me by the said affiant of this _____day of____________, 20__
Notary Public Signature Line
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