on behalf of
______________________________
(print or type name of petitioner)
In support of the application of the above named petitioner to the President of the United States for pardon, I, _________________________________
(print or type name of affiant)
residing at ________________________________________________________________
Number Street City State Zip Code
whose occupation is ________________________________________________________
certify that I have personally known the petitioner for ______ years. Except as otherwise indicated below, petitioner has
behaved since the conviction in a moral and law-abiding manner. My knowledge of petitioner's reputation, conduct and activities,
including whether the petitioner has been arrested or had any other trouble with public authorities and has been steadily
employed, is as follows:
________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________
I do solemnly swear that the foregoing information is true and correct to the best of my knowledge and belief.
______________________
(signature of affiant)
Subscribed and sworn to before me this _______ day of _________________, 19____.
_______________________
Notary Public
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