This page links to an example of a completed form. This is the actual form with sample text added in each section.
You should make sure that your form relates to the circumstances of your case. If you need more help to fill out your form, you should get
Do not try to file this sample form.
This sample form is provided in PDF
For instructions on how to fill out this form, see Instructions for filling out an Affidavit.
For more information on completing an Affidavit, see