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Unsworn Declaration (Texas Civil Practice and Remedies Code, Section 132.001) My name is: rs€Q//U/? ' WlF JLomOSO^J "ft First ft Middle f Last

my date of birth is: / / & I (fgl. and Month Day Year my address is: lUf) FM Z*M Jwhho/Ln TtXfiS ~)L<1XX StreetAddress City State Zip Code and Country My email address is MA (Ifyou are incarcerated, you must also include the following information.)

My inmate identifying number, if any, is: DI f$ 1 l^i/? 7.

Iam presently incarcerated in: / JMOlSejJ J^/l/)fr. J/9/1 IJ/JsT I / i £?Corrections Unit Name in: City Mj2.

County ^)rcX Tcxajs Itfft State Zip Code

I declare under penalty of perjury that all information in the attached document titled, KfQgp^f ffll a (oO Dal/ 5*kr*ihflA6 r\ Name of Document <r ,is true and correct.

Signed in lAr K County, Ttkfi <^ County State on this date: I I // I US' .

Month Day Year

Your Signature

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

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