AFFIDAVIT AS TO MILITARY SERVICE

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                          IN THE COUNTY COURT, IN AND FOR
a COUNTY, FLORIDA

casE No: /4- 0/042 9- CoS4

ole. a >
(Insert name of Landlord) ~ .
Plaintiff,
and
NONMILITARY AFFIDAVIT
ltt tleese Clagb en TO ,
(Insert name of Tenant)
Defendant.
STATE OF FLORIDA — )
COUNTY OF Tye

, being first duly sworn, states under penalty of perjury:

[AT that 1 know of my own personal knowledge that the respondent is not on active duty in
the armed forces of the United States.

(12. That Ihave inquired of the armed forces of the United States and the U.S. Public Health
Service to determine whether the respondent,

OO
is a member of the armed services and am attaching certificates stating that the
respondent is not now in the armed forces. a p

DATED: 1-9-2015” ZA

Signature of Affiant
Name ha,

Neme Zen She pigea | —__
St, pa Fz 27704

Telephone No. 229 - 4P4Y- “42.

Wo ary a z01S .
Acknowledged before me on _ , by who
[date] [name]

   
 
    

A personaty known tome/ [1 _ produced as identification, and who
[document]
TD ai…