I, ACCOUNT_FIRST_NAME ACCOUNT_LAST_NAME, the undersigned do hereby declare and affirm that:

1. I currently residing at the address of ADDRESS, and have been residing at this address for months

2. The aforementioned address is my primary and permanent residence.

3.  The reside at this address with the following individuals:

• INDIVIDUALS

I certify under the penalty of perjury under [State] law that information provided herein are true and correct to the best of my knowledge and belief.

Signature:

Name: ACCOUNT_FIRST_NAME ACCOUNT_LAST_NAME

Date Signed: 27 December 2024

State of ____________

County Of_____________

ACCOUNT_FIRST_NAME ACCOUNT_LAST_NAME of lawful age, being first duly sworn, upon his/her oat states that the information given in the above and the foregoing affidavit is true to the personal knowledge of this Affiant.

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