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: _________________

State of [STATE]
County of [COUNTY]

Subscribed and sworn to (or affirmed) before me on this [DAY] day of [MONTH], [YEAR], by [AFFIANT], proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me.

WITNESS my hand and official seal.

Signature: ________________________

My Commission Expires: _______________

(Seal)