STATE OF _____)
) ss.
COUNTY OF ____)
__[name]__, being first duly sworn, states that he/she is the petitioner/petitioner's agent in the above entitled matter; that he/she has read the foregoing Petition For Declaratory Order; and that the allegations of fact therein are true.
________________
[Petitioner's signature]
SUBSCRIBED and sworn to before me on this ___ day of ________, 199_.
NOTARY SEAL ___________________
[Notary signature]
Neb. Admin. Code ATTORNEY GENERAL, tit. 53, ch. 3, VERIFICATION