FORM B: AFFIDAVIT or AFFIRMATION IN SUPPORT OF MOTION UNITED STATES DISTRICT COURT WESTERN DISTRICT OF NEW YORK , , Plaintiff(s), AFFIDAVIT/AFFIRMATION IN SUPPORT OF MOTION v. ________-CV-___________ , , , , Defendant(s). STATE OF NEW YORK ) COUNTY OF ) ss.: (your residence) (Fill your name in one of the two blanks below, depending on whether you are having this notarized (use the firstline) or swearing to this under penalty of perjury (use the second line); cross out the unused line.)I, , being duly sworn, depose and say:I, , make the following affirmation under penalty of perjury:2. I am the plaintiff in the above-entitled action and respectfully request that the Court issue an order (briefly describewhat you want the Court to do) <<<<<<<<<********>>>>>>>>>>>>> 23. The reasons why I believe I am entitled to the relief I seek are set forth below. 4. (State the reasons why you believe that you are entitled to the relief you seek. Be specific and use short paragraphs.Add additional sheets of paper if necessary; also attach copies of any exhibits to which you refer in your affirmation.) 5. I declare under penalty of perjury that the foregoing is true and correct, to the best of my knowledge, information andbelief. Dated: ____________________________ (Your Signature)(Have this section completed if you are having this document notarized) Sworn to before me this day of , 20 . Notary Public 2
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