Use this form when responding to discovery or other pleading which specifically requires that your response be verified.
1234, Main Street
Boston, MA 02123
06 April, 2005
<Recipient Address Goes Here>
STATE OF <state>
COUNTY OF <county>
I, the undersigned, declare that I am a <party you are to the lawsuit> in the above-entitled action. I have read the foregoing <title of document you are verifying> and know the contents thereof. The contents of said document are true to the best of my knowledge, except as to the matters which are therein stated upon my information and belief, and as to those matters, I believe them to be true.
I declare under penalty of perjury, under the laws of the State of <state> that the foregoing is true and correct.
Executed this ______ day of ____________________, _______, at <city>, <state>.
encl: <List of enclosed items goes here>