Esq., being first duly sworn, deposes and says: 1. Fill out the Request for Service form.Once you fill out the poverty affidavit, you must have your signature notarized and file the completed affidavit in the court where your case is being heard. The Verification Affidavit is a legal document used to affirm the truthfulness of the statements made within a complaint. The motion must include an affidavit (sworn statement) explaining how the other party is failing to follow the court's order. An affidavit is a sworn statement. It carries the same weight as a statement made in court under oath. Complete BMV 1173 Form and check the box. "Last Known Address" and "Copy of. Pretrial Statement And Affidavit Form.