__________, being first duly sworn, says that he (or she) has read the foregoing document and knows the contents thereof and that the facts set forth therein are true, except as to matters therein stated on information and belief, and as to such matters he believes them to be true, and that he (or she) is duly authorized to sign the document.
Subscribed and sworn to before me this ___ day of ________, 19__.
(Notary Public)
7 C.F.R. §47.20