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S)/Debtor(s) My name is (Full name) I live in (Municipality & province) I make this affidavit to support my motion for payment out of court of money belonging to (Name of person under disability) of , (Address) who is (State the nature of the disability) and who was born on I am . (Date) . (State your connection with the person under disability) The Accountant has informed me that $ (Date) , including interest accrued to , is in court. There has been previously paid out the su.

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