I [Enter Name] (“Affiant”), of address [Enter Address], who being duly sworn according to law, do make an oath and states as follows:
[Enter Name] of address [Enter Address] is _____ [Enter the relationship between you and the person].
[Enter Name] perpetrated fraud as follows:
[Describe incidence(s) of fraud]
Upon my information and belief, I have duly stated any and all information I have with regards to the fraudulent conduct of [Enter Name].
I understand that an investigation may be done on the facts stated in this Affidavit, and that a civil and/or criminal action against [Enter Name] may be brought for their fraudulent conduct stated herein.
I agree to testify, declare, depose, certify or acknowledge the truth of any or all of the statements contained herein before a court of competent jurisdiction, officer or person thereof.
I recognize that any false statement or other misrepresentation made in this Affidavit, may subject me to civil and/or criminal penalties. I further understand that I may not recover for any loss or expense caused by the alleged fraudulent conduct, if I provide false information herein.
I hereby swear under the penalty of perjury that the facts referred to in this affidavit are true, complete and correct.
Signature of the Affiant: [Your Name] [Your Signature] ______________________ [Enter Date]
For the Notary:Sworn to before me this _________ day of _______________________ [Signature] ____________________________ Notary PublicState of [Enter State]My Commission Expires: ___________
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