Utah Code § 78B-18a-106

Form of unsworn declaration
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An unsworn declaration under this chapter must be in substantially the following form:
 I declare under criminal penalty under the law of Utah that the foregoing is true and correct.
 Signed on the ___ day of ______, _____, at ________________________________.
 Date Month Year City or other location, and state or country
 ________________________
 Printed name
 ________________________
 Signature

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