I. Introduction

A. Identification of Affiant

• Full Name: [Full Name of Affiant]

• Address: [Address of Affiant]

• Contact Number: [Contact Number of Affiant]

B. Purpose of Affidavit

This affidavit is prepared to support the complaint of [Name of Signatory] seeking relief from abuse. It attests to the veracity of the claims made in the complaint and provides legal evidence of the need for protection from abusive situations.

II. Statement of Facts

A. Description of Relationship with Abuser

• Nature of Relationship: Former spouse

• Duration of Relationship: 5 years

• Instances of Abuse: Multiple incidents of physical and emotional abuse

B. Description of Abuse

• Physical Abuse: Bruises, cuts, and broken bones resulting from physical altercations

• Emotional Abuse: Verbal threats and manipulation

• Financial Abuse: Control over finances and withholding financial support

III. Supporting Documentation

A. Exhibits Attached

• Incident Reports

• Medical Records

• Witness Statements

B. Explanation of Attached Documents

The incident reports detail specific instances of abuse documented by law enforcement. The medical records provide evidence of injuries sustained as a result of the abuse. Witness statements corroborate the affiant's claims.

IV. Notary Certification

A. Sworn Statement of Affiant

• "I, [Full Name of Affiant], hereby declare under penalty of perjury that the foregoing is true and correct to the best of my knowledge and belief."

[AFFIANT'S NAME]

[DATE SIGNED]

B. Notary Public Acknowledgment

On this [DATE OF NOTARIZATION], before me, the undersigned notary public, personally appeared [Full Name of Affiant], known to me (or proved to me based on satisfactory evidence) to be the person whose name is subscribed to the within instrument, and acknowledged that he/she executed the same in his/her authorized capacity and that by his/her signature on the instrument, the person, or the entity upon behalf of which the person acted, executed the instrument.

Witness my hand and official seal.

[NOTARY PUBLIC NAME]

Notary Public Commission Number:                              

My Commission Expires:                               

Seal: (Place Notary Seal Here)

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