Illinois elements of affidavit of lost or destroyed document

STATE OF ILLINOIS

I, the undersigned, being duly sworn, do hereby depose and say:

1. I am over the age of 18 and am a resident of the state of . I have personal knowledge of the facts in this affidavit, and, if called as a witness, could testify competently about them.

2. I am currently living at: , , .

Under penalties as provided by Illinois law, the undersigned certifies that the statements set forth in this instrument are true and correct.

Executed this _____ day of ____________, 20____ in _______________________.__________.

STATE OF ILLINOIS

COUNTY OF ____________________

This instrument was acknowledged before me on _________________, 20____, by . This instrument was acknowledged before me on _____________________, 20____, by as _________________________________________ of . Signed and sworn (or affirmed) to before me on ____________, 20___, by .