49 CFR 1112.9 - Sample verification for statement of fact under modified procedure.
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§ 1112.9 Sample verification for statement of fact under modified procedure.
State of __________,
County of __________,
__________ being duly sworn, deposes and says that he has read the foregoing statement, knows the facts asserted there are true and that the same are true as stated.
Subscribed and sworn to before me this _____ day of __________.
Notary Public of __________.
My Commission expires __________.