This action is brought by ________________, Plaintiff, age____ , who resides at __________________, City of ______________, whose Social Security # is _________ , and who is employed as a _____________ at _______________, located at __________________, City of _____________ , State of_________________.
The Defendant in this action is ___________, age ___, who resides at _______________________, City of _____________________, whose Social Security # is __________, and who is employed as a ____________ at _________________, located at _______________________, City of _________________, State of ____________________.
The undersigned Plaintiff states, under oath, the following:
1. RESIDENCY. Plaintiff has been a resident of and domiciled in the State of ___________ for the preceding ______________ and the County of ________________ for the preceding ___________________.
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