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NOTICE: THIS FORM CONTAINS SENSITIVE DATA.
Unsworn Declaration
(Texas Civil Practice and Remedies Code, Section 132.001)
My name is: rvea/Ai/) \)Or4r~, Jh*rr\()SC>Al
iQ.
First ft Middle
t I iLast
my date of birth is:
Month
/ i ^ i fin.
Day Year
and
my address is: 11*30 FM ^W J^kshofi-T) TtXfiS lUStf
Street Address City State Zip Code
and J/iak.
Country
My email address is _ ML
(If you are incarcerated, you must also include the following information.)
My inmate identifying number, if any, is: D ( t/}f-r. J/}/'I IJaji'I
(f Corrections Unit Name
in:
City
MAP
County
JflfiC Tex/E.s IMS*.
State Zip Code
declare under penalty of perjury that all information in the attached document titled,
, is true and correct.
pi Name ofDocument &
Signed in A }*r(<
County
.County, l-ckfl <,
State
on this date: i i // i hr
Month Day Year
Your Signature
Pursuant to Texas Civil Practice and Remedies Code Section 132.001, an unsworn declaration may be
used in lieu of a written sworn declaration, verification, certification, oath, or affidavit required by statute or
required by a rule, order, or requirement adopted as provided by law. This provision does not apply to an
oath of office or an oath required to be taken before a specified official other than a notary public. An
unsworn declaration made under this section must be 1) in writing, 2) signed by the person making the
declaration as true under penalty of perjury and 3) in substantially the form used above.
)TexasLawHelp.org - Unsworn Declaration, August 2012 Page 1 of 1