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Mary Louise Nicholson, County Clerk

Affidavit of Age and Identity


Colorado
THE STATE OF __________________
weld
COUNTY OF ____________________

Oscar Spencer Ramirez


Before me, the undersigned authority, on this day personally appeared __________________________
Oscar Spencer Ramirez / FILE NO. : 165673-1964
, known to me to be the person
(name of applicant)
09/21/1964
who subscribed their name below, and have verified their date of birth is _________________________ .
(MM/DD/YYYY)

Signature of Applicant

Oscar Spencer Ramirez


Print Full Legal Name of Affiant as shown on identification provided

Subscribed and sworn to before me on this day of , 20 .

(Signature of Notary Public)

Seal

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