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Get DFS-A4 2007-2024

124 1 FS the claimant must produce to the notary photographic foreign nation or a political subdivision or agency thereof. Form DFS-A4-2007 Effective 10-13-10 incorporated into Rule 69I-20. NOTARIZED SWORN STATEMENT OF THE CLAIMANT Claim Number After being duly sworn the affiant states as follows My full name is. My current address is Street Address City County State ZIP Code My date of birth is month date year Signature of Affiant STATE OF COUNTY OF Sworn to and subscribed before me this day of.

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