Affidavit Verifying No Civil Litigation

CITY OF BATON ROUGE FILE/TRAFFIC NO.: __________________ BATON ROUGE CITY COURT VS. CITY OF BATON ROUGE STATE OF LOUISIANA AFFIDAVIT VERIFYING NO CIVIL LITIGATION I do hereby declare, under penalty of perjur*, that I have not been sued in connection with y this proceeding, nor has any civil judgment been rendered against me concerning the facts that resulted in this traffic infraction. Baton Rouge, Louisiana, on this _________ day of ______________, 20 ____ . _____________________________ Defendant SWORN TO AND SUBSCRIBED, BEFORE ME, on this _____ day of ____________, 20 ____. _________________________________ Notary Public * I understand that an INTENTIONALLY FALSE DECLARATION herein would subject me to PROSECUTION for PERJURY, which is a FELONY, PUNISHABLE upon conviction b y IMPRISONMENT UP TO FIVE (5) YEARS at HARD LABOR (La R.S. 14:123). Civil Affidavit Verifying No Civil Litigation (04-25-03)