Sample Affidavit of No Insurance

1. I am over the age of eighteen;
2. I have personal knowledge of the facts set forth below.
3. On October 30, 2006, I was involved in an automobile accident.
4. At the time of the accident I did not have automobile insurance coverage.
5. The vehicle I was driving was not covered by any policy of insurance.

I do hereby testify under the penalties of perjury that the information contained within this affidavit is true and correct to the best of my knowledge and belief.

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