STATE OF ________________________

Before me this day personally appeared the undersigned Affiant who, being duly sworn, deposes and says:
I, as Witness to Proceedings, and a Lawful Man or Woman over the age of majority, and having firsthand knowledge of the facts herein, hereby timely say that I witnessed on the below date the following behaviors and activities in the room and location, and related to the Public Officer and Case number below, and I hereby certify the non-misleading fact, truth, accuracy, and material completeness of my statements to the best of my knowledge and belief, with no intent of improper purpose such as to harass, cause unnecessary delay, or increaselitigation cost:

Date of event: ________________Room: _______________________________
Address/Location: _______________________________________________________________________
Presiding Officer, Magistrate, or Judge: _____________________ Case # ______________________
Behaviors and Activities Witnessed:

Further, Affiant says naught.
______________________________________ Date:__________________
Signature of Affiant and Witness to Proceedings
On ___________________ (day month year), the above-named Affiant, personally known to me, or having produced identification of known type, swore to (or affirmed), subscribed, and acknowledged before me the above affidavit.

Notary Signature: ___________________________ Notary Name (print): _____________________________
State of: __________ Commission expires:________________________