2
This day of , 20 .
Signature of First Petitioner Signature of Second Petitioner, if any
Printed Name Printed Name
Mailing Address Mailing Address
Telephone Number Telephone Number
VERIFICATION
GEORGIA, ROCKDALE COUNTY
Personally appeared before me the undersigned Petitioner(s) who, after being duly sworn,
state(s) that the facts set forth in the foregoing Amendment and any attached Exhibit(s) are true
and correct.
Sworn to and subscribed before me this
______ day of _______________, 20_____ ____________________________________
Signature of Petitioner
___________________________________ _____________________________________
NOTARY/CLERK OF PROBATE COURT Printed Name of Petitioner
My Commission Expires: ________________
Sworn to and subscribed before me this
______ day of _______________, 20_____ ____________________________________
Signature of Second Petitioner, if any
___________________________________ _____________________________________
NOTARY/CLERK OF PROBATE COURT Printed Name
My Commission Expires: ________________