AFFIDAVIT

I am a Urantian believer. I believe the Urantia Papers were authored
entirely by celestial beings, and are a divine gift to all the people of
our planet. The Urantia Papers are the basis of my personal religious
beliefs. The three concentric azure blue circles on a white background
have special religious significance to me. It is my belief that these circles are the emblem of Michael of Nebadon, our Creator Son who lived on
our planet Urantia as Jesus of Nazareth. The three concentric azure blue
circles on a white background are also the material symbol of the Paradise
Trinity of all creation, and was used by Melchizedek when he was on
Urantia. I have often seen Urantians use the three concentric azure blue
circles on a white background as an expression of religious beliefs.

Signed: ____________________________________________________

Date:________________________

Print Name: _________________________________________________

Address: ____________________________________________________

City, State and Zip: ____________________________________________