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Get FL 12.922(c) 2000

Date . Other party or his/her attorney: Name: Address: City, State, Zip: Fax Number: I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this motion and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: Signature of Respondent Printed Name: Address: City, State, Zip: Telephone Number: Fax Number: STATE OF FLORIDA COUNTY OF Sworn to or affirmed and signed before me on by . NOTARY PUBLIC or DEP.

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