RECIPROCAL OF AMERICA AND
THE RECIPROCAL GROUP
  In Receivership for Liquidation  

 

     

APPENDIX I - JURAT

Below is as example of statement to use to make sure a Notice of Appeal is sworn:

State of ___________________________

County of _________________________

 

BEFORE ME, the undersigned authority, on this day personally appeared _______________________ known to me to be the person whose name is subscribed to the foregoing NOTICE OF APPEAL, and having by me been first duly sworn, upon his (her) oath deposed and stated that the facts therein contained are true and correct to his (her) knowledge or belief.

Given under my hand and seal of office on this _____ day of , 20__.

   
(Notary Seal)  

_______________________________

 

 

(Notary s name)
    Notary public in and for
    _________________________ County,
    State of _________________________
     
See THE RECEIVERSHIP APPEAL PROCEDURE FOR THE ADJUDICATION AND APPEAL OF CLAIM DECISIONS.