Before me the undersigned authority personally appeared ______________________________, of __________________, who, after being duly sworn according to law, doth depose and say:
1. That I am _______ years old.
2. That I have been shown a map of Tract No. ______________, _____________ ________________Refuge, a print of which map is attached to and made a part of this affidavit; that I fully understand said map; and I am familiar both with the boundaries of the land thereon shown and designated as aforesaid and with the use and occupancy thereof, by reason of my residence within the vicinity of said land for _________years.
3. That the possession of said land is now and has been in ________________________ and his (their) predecessors in title since _____________, and that this possession has been since that date and is now, open, hostile, exclusive, notorious, uninterrupted, active, and adverse to any other claims or interests, and that to my own personal knowledge the said _________________ exercised the following acts of ownership upon said land:
4. That I am a disinterested person having no interest whatsoever in the transaction involved and make this affidavit with full understanding that the same to be used by the United States of America as part of the abstract of title covering said land.
Subscribed and sworn to on this ______day of ___________, 19__.
My commission expires: