) s.s.:

COUNTY OF ---------)

The undersigned, being duly sworn, deposes and says:

I am over the age of eighteen years, and, on [date], I mailed the [paper mailed, e.g., notice of default], copy of which is attached [omitted], to the addressee listed below, by depositing a copy enclosed in a postpaid wrapper, in an official depository under the exclusive care and custody of the [Country] Post Office Department, in [city, county, state] addressed as follows:

[name and address of addressee]

[signature]

Affiant

Sworn to before me this [dated].

[signature]

Notary Public