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AdozenpeopleonStevensCounty
completedadeclarationsimilartothis.
AndfurtherDeclarantsayethnaught.
IdeclareunderpenaltyofperjuryunderthelawsoftheUnitedStatesofAmericathattheforegoing
istrueandcorrect.
Executedonthis____dayof__________________,2014.
PrintedName:_________________________Autograph:________________________
Declarant
Address:___________________________,_________________,Washington,Zip[__________
DeclarationinSupportof1
st
AmendmentCriminalComplaintagainstTimothyRasmussen Page1of1
Mycountry,rightorwrong.Ifright,tobekeptright;andifwrong,tobesetright.CarlShurz