58 Pa. Code § 495a.5
(b) The verification form should comply substantially with the following:
I,
, hereby state that the facts above set forth are true and correct (or are true and correct to the best of my knowledge, information and belief). I understand that the statements herein are made subject to the penalties of 18 Pa.C.S. § 4904 (relating to unsworn falsification to authorities).
Date:
(c) When an affidavit is used, the form should comply substantially with the following:
I,
(Affiant) being duly sworn (affirmed) according to law, depose and say that (I am authorized to make this affidavit on behalf of corporation, being the holder of the office of with that corporation,) and that the facts above set forth are true and correct (or are true and correct to the best of my knowledge, information and belief).
(Signature of affiant)
Sworn and subscribed before me this
day of , 20 .
(Signature of official administering oath)