This form is a generic example that may be referred to when preparing such a form for your particular state. It is for illustrative purposes only. Local laws should be consulted to determine any specific requirements for such a form in a particular jurisdiction.
Para su conveniencia, debajo del texto en espaƱol le brindamos la versiĆ³n completa de este formulario en inglĆ©s. For your convenience, the complete English version of this form is attached below the Spanish version.