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Unsworn Declaration
['Texas Ci`vi`/ Practice and Remedies Code,' Section 132. 001)

 

 

 

My name is: W\,M\FC\\/‘A.@$ - DV\\{`Q/ i/V\.O L.i l\(p(i/Q
Fi'rst i'.lidd/a Last
my date of birth is: 0 \ l § / %Q~ , and 4
.‘.lonth Day Year b '
my address is: 1910 FM 331`!"{ :)_0\(/\<5`00 ("o “Y{;(ai$ 71le 573

Street Address City $lata Z/'p Code

_Country

 

(lf you are incarcerated, you must also include the following information.)
o
My inmate identifying number, if any, is:“‘&@ \QASQLKO
l am presently incarcerated in: l `.\i~\bs@\,\ . %'\0\&€ \-)M\ W\/ig\f

Con'ections Unit Namo

im \iiioi<siooio Fi>\ci< J le ms /lip‘i€B.

Cily ' County Slate le Code

l declare under penalty of perjury that all information in the atta hed document titled,
_ l _ . 7 \ _

Pai}iioiidg obieciioi\ iii tie §ii<ics R€SDOM ”§ jf\‘\“l\\“bi5 fix

MMA Comi/!ulj'lgd'§ 0 k\ Lg _ame ofDocumenl \ t "

Signed in TO\ ('/ (< County, 179 KM_$-

Coun!y Slata

onthisdate: 06 /O\°\ / \§ .

l.lonth Da};_ Year M//Z 0
Your Slgna jure `

. is true and correct.

 

Pursuant to Texas Clvil Practice and Remedies Code Section 132.001,- an unsworn declaration may be
used in lieu of a written sworn deciaration, verification. certification, oath, or affidavit required by statute or
required by a ruie, 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.

-‘D TexasLawHelp.org - Unsworn Dec/arat/on. August 2012 Page 1 of 1

 

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.`/

