_COMMONWEALTH OF MASSACHUSETTS
You are submitting this affidavit. Put your name in the blank after AFFIDAVIT OF _____. On the blank lines, list the facts the judge needs to know about what happened and when. Put the date you sign the affidavit at the bottom of the form. Sign the affidavit where it says signature. Remember when you sign this affidavit; you are . swearing ................
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