Common Uses
An affidavit of forgery can be used in cases of identity theft or in civil or criminal court, but it is most often used when bank instruments (such as checks, loan notes, share drafts, and cash withdrawal vouchers) have been altered or the signatures on them have been forged.
Identity Theft
In identity theft cases, individuals must submit a claim to the Federal Trade Commission (FTC), which may require the completion of an Identity Theft Affidavit (IRS Form 10439).
Sample
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AFFIDAVIT OF FORGERY
Date: [MM/DD/YYYY]
1. THE AFFIANT. I, [AFFIANT NAME], with an address of [AFFIANT ADDRESS], being duly sworn, hereby swear under oath that the information stated in this affidavit of forgery is true and correct.
2. FORGED DOCUMENT. The forged instrument is best described as: (check one)
☐ Check
☐ Share Draft
☐ Loan Note
☐ Cash Withdrawal Voucher
☐ Other: [TYPE OF INSTRUMENT]
3. FORGERY DETAILS. The forgery is best described as: (describe in full)
[DESCRIBE FORGERY]
4. POLICE REPORT. A police report: (check one)
☐ Has been filed and was recorded on [MM/DD/YYYY].
☐ Has NOT been filed but the affiant intends to file in the near future.
☐ Has NOT been filed but can be filed if required to process this affidavit.
☐ Other: [POLICE REPORT DETAILS]
I, [AFFIANT NAME], the affiant, did not receive any part of the proceeds of the instrument listed above. This affidavit is made voluntarily for the purpose of establishing the fact that an instrument was forged. I understand that this forgery is subject to investigation by local, state, and federal law enforcement agencies and that I may be required to comply with a court order or subpoena to give testimony. I understand making a false sworn statement is subject to federal and state statutes and may be punishable by fines or imprisonment.
Affiant Signature: ______________________________ Date: _______________
NOTARY ACKNOWLEDGMENT
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. |
State of [STATE]
County of [COUNTY]
The foregoing instrument was acknowledged before me, [NOTARY PUBLIC NAME], on [MM/DD/YYYY], by the undersigned, [AFFIANT NAME], who is personally known to me or satisfactorily proven to me to be the person whose name is subscribed to the within instrument.
WITNESS my hand and official seal.
Signature: ________________________
(Seal)