AFFIDAVIT

STATE OF NORTH CAROLINA

COUNTY OF WAKE

______________________________________ (name of affiant), appearing before the undersigned notary and being duly sworn, states the following:

1. My full name is ____________________________________ .

2. I am a citizen of a foreign country and am not a citizen or national of the United States.

3. I am not eligible for a Social Security number

Signature of affiant _______________________________________

Sworn to (or affirmed) and subscribed before me this _________ day of ______________ , 20____ .

___________________________

Notary Public