State of Florida County of ____________ Sworn to and subscribed before me this ____ day of _________, 2006 by (name of person signing the document.) ___________________ Notary Public Personally known ____ OR Produced ID _____ Type of ID Produced ___________________________________ For the I-171H, passport pages or any other document notarized as a COPY, please use the following affirmation: STATE OF FLORIDA COUNTY OF _________ On this _______ day of _________ (year), I attest that the preceeding or attached document is a true, exact, complete, and unaltered photocopy made by me of ______________(description of document) presented to me by the document's custodian, _______________, and, to the best of my knowledge, that the photocopied document is neither a vital record nor a public record, certified copies of which are available from an official source other than a notary public. _______________________ (notary signature) print, type or stamp name of notary (seal)