I agree with nextwife and that is what I am talking about. We don't really know where the problem is as the OP is a little fuzzy on where those statments are on the form. But, I've seen pre-filled in forms where the notary couldn't affirm because of the county was printed differently from where the signature is going to take place.
My questions were trying to get the OP to tell us what he wants the notary to swear to. If the problem state and county were in an inappropriate area, obviously the notary couldn't do their job.