CITY OF BATON ROUGE
VS.
FILE/TRAFFIC NO.: __________________ BATON ROUGE CITY COURT CITY OF BATON ROUGE STATE OF LOUISIANA
AFFIDAVIT VERIFYING NO CIVIL LITIGATION
I do hereby declare, under penalty of perjury*, that I have not been sued in connection with this proceeding, nor has any civil judgment been rendered against me concerning the facts that resulted in this traffic infraction.
Baton Rouge, Louisiana, on this _________ day of ______________, 20 ____.
_____________________________
Defendant
SWORN TO AND SUBSCRIBED, BEFORE ME, on this _____ day of ____________, 20 ____.
_________________________________ Notary Public
* I understand that an INTENTIONALLY FALSE DECLARATION herein would subject me to PROSECUTION for PERJURY, which is a FELONY, PUNISHABLE upon conviction by IMPRISONMENT UP TO FIVE (5) YEARS at HARD LABOR (La R.S. 14:123).
Civil Affidavit Verifying No Civil Litigation (04-25-03)