STATE OF ----------)
COUNTY OF ---------)
[Name in capital letters] (Affiant), being duly sworn, says:
1. I reside at [address, city, state of Affiant].
2. I am Attorney-in-Fact for [name of principal] under power of attorney executed by [principal], dated [date]. As of the date of this Affidavit, [principal] is alive and well, and has agreed to the terms of [description of contract, e.g., sale of land, goods].
3. This Affidavit is made for the purpose of inducing [name] to [description of purpose, e.g., to induce a party to accept a conveyance, a bank to provide a loan].
Sworn to before me this [dated].