[State name] State
[County name] County
I, the undersigned, hereby announce that I am a [party type in the lawsuit] in the above-entitled action.
I have read the abovementioned [document name to verify], and know the contents of these papers thereof. The information in these documents is true to the best of my knowledge, apart from the subjects which are affirmed based on my information and belief, and as to those matters, I deem them to be true.
I confirm under the perjury punishment, under the laws of the State of [state name], that the abovementioned is true and correct.
Executed this ______ day of [day] & [date] at [city name], [state name].