AFFIDAVIT, LOG OF MEASURED FREQUENCIES

The following frequencies were scanned and measured by (name) ___________________________________
and recorded as entered in the table below.

DATE

TIME

METER MODEL

LOCATION SCANNED

MAX READING

NOTES




















































































































I swear under penalty of perjury that the above is true, complete and correct to the best of my knowledge.


SIGNED (Affiant)_______________________________________________________


NOTARY

State of _____________

County of ____________


On _________ before me, ________________________________________,

(name of notary public )

personally appeared _____________________________________________

who proved to me on the basis of satisfactory evidence to be the person(s)

whose name(s) is/are subscribed to the within instrument and who acknowledged

to me that he/she/they executed the same in their authorized capacity(ies),

and by his/her/their signature(s) on the instrument the person(s), or entity

upon behalf of which the person(s) acted, executed the instrument.


I certify under PENALTY of PERJURY under the laws of the state of California

that the foregoing paragraph is true and correct.


WITNESS my hand and official seal.



____________________________

(Signature of Notary)