_________________________,(Petitioner's name), being duly sworn, deposes and says that he/she is the _________________________ (relationship to child) in this proceeding, that he/she has read the annexed ____________________ (petition/answer) and knows the contents thereof, that the same is true to the knowledge of deponent except as to the matters therein stated to be alleged upon information and belief, and as to those matters he/she believes it to be true.

                                                                                                        _____________________
                                                                                                            (signature)

Subscribed and sworn to before me
this ________ (date) day of _______________ (Month and Year).

_______________________________
(Notary Public)