AFFIDAVIT OF IDENTITY

I, the Affiant, being duly sworn, hereby affirm on [MM/DD/YYYY] that:

• My legal name is [AFFIANT NAME].
• My date of birth is [MM/DD/YYYY].
• I currently reside at the following address: [AFFIANT ADDRESS].
• My telephone number is: [AFFIANT PHONE NUMBER].
• I have presented to the notary public:
  ☐ – Driver’s License
  ☐ – Passport
  ☐ – Identity Card
  ☐ – Other: [DESCRIBE ID].
• I understand that false statements on this Affidavit may be punishable by the fullest extent of the law.

Under penalty of perjury, I hereby declare and affirm that the Affidavit is signed by me and all its contents, to the best of my knowledge, are true and correct.

Affiant’s 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]

On [MM/DD/YYYY] before me, [NOTARY NAME], personally appeared [AFFIANT NAME] who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that they executed the same in their authorized capacity, and that by their signature on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

I certify under PENALTY OF PERJURY under the laws of the State of [STATE] that the foregoing paragraph is true and correct.

WITNESS my hand and official seal.

Signature: ____________________________         (Seal)
Print Name: _____________________________