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Get Affidavit Of Witness

This authorization will be in effect until in the presence of Signed By Signature of Authorizing Person Signature of Witness See Affidavit of Witness form to complete GS 121 2001/12 Page 1 of 2 Affidavit of Witness CANADA IN THE PROVINCE OF ALBERTA Name of the Witness in Full Occupation of Witness of Complete Home Address of Witness make oath and say that 1. Authorization of Representative I in the province of living at authorize as my personal representative to act on my behalf and to exercise select one all my rights under the Freedom of Information and Protection of Privacy Act my right to access all my records containing personal information in all categories of personal information categories of personal information number and titles of records or categories the rights that I have under the Freedom of Information and Protection of Privacy Act regarding the following other matters e*g* consent to disclose personal information I confirm that my representative has the authority to exercise the above right s under the Act for me. I was personally present and I saw Name of Individual sign the Authorization of Representative form to which this is attached* 2. The Authorization of Representative form was signed by at and that I am the one who witnessed the form* and I believe that he/she is 3. I know 18 years of age or older. Sworn before me at on Commissioner for Oaths Print Name Expiry Date of Commission. I was personally present and I saw Name of Individual sign the Authorization of Representative form to which this is attached* 2. The Authorization of Representative form was signed by at and that I am the one who witnessed the form* and I believe that he/she is 3. The Authorization of Representative form was signed by at and that I am the one who witnessed the form* and I believe that he/she is 3. I know 18 years of age or older. Sworn before me at on Commissioner for Oaths Print Name Expiry Date of Commission. I was personally present and I saw Name of Individual sign the Authorization of Representative form to which this is attached* 2. The Authorization of Representative form was signed by at and that I am the one who witnessed the form* and I believe that he/she is 3. I know 18 years of age or older. Sworn before me at on Commissioner for Oaths Print Name Expiry Date of Commission.

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