STATE OF CALIFORNIA, COUNTY OF Santa Clara,
(Affiant's Name)
, being first duly sworn, deposes and says:
That there was charged to the affiant's account at the Star One
Credit Union the check/share withdrawal/share draft purporting
to be signed by affiant as maker, described in the following schedule:
That the purported signature of affiant on each of said checks/withdrawals/share
drafts is a forgery; that none of said checks/withdrawals/share
drafts was signed or issued by affiant or by any person authorized
by affiant to sign same; that affiant has no knowledge or information
respecting the circumstances under which any of said checks/withdrawals/share
drafts was signed or issued or the persons who signed same except:
That affiant received no benefit or value from the proceeds of
any said checks/withdrawals/share draft and that no part of any
said checks/withdrawals/share drafts was applied to any use or
purpose in affiant's behalf.
That this affidavit is made for the purpose of having Star One
Credit Union reimburse affiant for the amount of said checks/withdrawals/share
drafts.
That affiant will testify, declare, depose or certify to the truth
of each and all of the foregoing before any competent tribunal,
officer or person, in any case now pending or that may be hereafter
instituted in connection with the matters contained in this affidavit.
Affiant's Signature X________________________________
