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:________________________________________

Address:_________________________________________________________________________

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: _____________________________________________

 

                                                                                                 _______________________
                                                                                                 AFFIANT

 

Subscribed and Sworn to before me by the said affiant of this _____day of____________, 20__

                                          Notary Public Signature Line

 

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