Statutory Declaration - Queensland

Oaths Act 1867
Statutory Declaration
QUEENSLAND
TO WIT
I,
of in the State of Queensland
do solemnly and sincerely declare that
And I make this solemn declaration conscientiously believing the same to be true, and by virtue of the
provis
ions of the Oaths Act 1867.
Signature of declarant/deponent
Taken and declared before me at
this day of
A Justice of the
Peace/Commissioner for
Declarations.
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