AFFIDAVIT OF RESIDENCE

Name: [AFFIANT NAME]
Address: [AFFIANT ADDRESS]
City, State, ZIP: [AFFIANT CITY, STATE, ZIP]

Date: [MM/DD/YYYY]

To Whom This May Concern,

I, [AFFIANT NAME], formally acknowledge living at the street address of [AFFIANT ADDRESS, CITY, STATE, & ZIP]since [MM/DD/YYYY]. I have attached the following documents for your consideration: [DESCRIBE DOCUMENTS]

Furthermore, I swear and affirm under penalty of perjury that the facts set forth in this statement are true and accurate.

Sincerely,

_____________________

Witness Acknowledgment

I/We, as witness(es) to the aforementioned claims made by [AFFIANT NAME] and acknowledge their residency status.

Witness Signature: _____________________ Date: _________________Print Name [WITNESS NAME]

Witness Signature: _____________________ Date: _________________
Print Name: [WITNESS NAME]

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)