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-511 s M- <br />L the undersigned, on my oath as a corporate officer, and duly authorized to make this <br />Affidavit on behalf of (Company Name) <br />hereby swear and affirm that the documentation and information prepared under my direction and <br />attached hereto, containing the names, hire dates, wage levels and place of residence of those <br />employees filling (number) m_ new, full-time jobs created during the calendar year <br />ww , in accordance with the terms of the (check all that apply) incentive and/or <br />abatement agreement(s) dated —11111111111-1-111111-1, 20 , are, in all things true <br />and correct. <br />Witness my hand this — , .. ......._ day of m.m......m _.�, 20 <br />Name: <br />Title: <br />Signature: <br />STATE OF TEXAS } <br />} <br />COUNTY OF LAMAR ) <br />BEFORE ME, the undersigned authority, on this day personally appeared <br />known to me to be the person whose name is subscribed to the <br />foregoing instrument and acknowledged to me that he/she executed the same for the purposes and <br />consideration therein expressed and in the capacity therein stated. <br />GIVEN UNDER MY HAND AND SEAL OF OFFICE, this day of <br />Notary Public, State of Texas <br />