The City Of Turia Statement scroll (SLName and date)

 Name:**Display Name (SL Name)**

Written statement:

I **Display Name (SLName)** declare that on MM/DD/YYYY....

I declare under penalty of perjury under the laws of the laws of the City Of Turia that the foregoing is true and correct.

Signed:

Date:

Seal:

Scribe:

Date:

Seal:

**Attach NCs of the RP if available**