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home :: Freedom of Information Act :: sample verification of identity certification

Sample Verification of Identity Certification

City of [       ], County of [       ]

[Name of individual], who affixed (his)(her) signature below in my presence, came before
me, a [title:      ], in and for the aforesaid County and State, this [day] day of [month], [year],
and established (his)(her) identity to my satisfaction.

My commission expires on [date].

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