I, Richard Roe, of the City of New York, County of Erie, and State of New York, being duly sworn, depose and say: (Here insert the body of the affidavit, setting forth what the maker of the affidavit swears to and stating whether it is of his own knowledge or upon information and belief.)

RICHARD ROE.

Subscribed and sworn to before me this 15th day of June, A. D., 1914.

HOWARD SHERMAN, (Seal) Notary Public.

(2) Jurats To The Above Affidavits

Subscribed and sworn to before me this 15th day of June, 1914, by the above named Richard Roe, an illiterate, (or blind person, as the case may be), said affidavit having been first read to him by me, and he appearing to me to understand the same.

HOWARD SHERMAN, (Seal) Notary Public.

Subscribed and sworn to before me this 15th day of June, 1914, by the above named Richard Roe, who is a foreigner not understanding the English language, said affidavit having first been interpreted to the affiant by Tom Smith, an interpreter, first duly sworn for that purpose.

HOWARD SHERMAN, (Seal) Notary Public.