Affidavit of Identity

AFFIDAVIT OF IDENTITY

Before you use this: Ask the recipient whether it requires its own form, particular identification, or a local notarial certificate. Complete the oath before an officer authorized where it is taken.

State or other jurisdiction: [JURISDICTION]

County or locality: [COUNTY / LOCALITY]

I, [FULL LEGAL NAME], having been duly sworn or affirmed, state from personal knowledge:

1. My current legal name is [FULL LEGAL NAME]. My date of birth is [__/__/____]. My current address is [ADDRESS].
2. I am the same person identified in [DESCRIBE THE RECORD, ACCOUNT, TRANSACTION, OR PRIOR NAME]. The name or other identifier appearing there is [IDENTIFIER AS SHOWN].
3. The difference between that record and my current identification is explained as follows: [EXPLAIN NAME CHANGE, SPELLING DIFFERENCE, OR OTHER DISCREPANCY; WRITE “NONE” IF NOT APPLICABLE].
4. I present the following identity evidence: [DOCUMENT TYPE, ISSUING BODY, DATE, AND ONLY THE LAST FOUR CHARACTERS OF ANY NUMBER]. Copies marked [EXHIBIT LETTERS] are attached, if needed. I identify these copies as copies of the documents described here.
5. This affidavit is submitted to [RECIPIENT] for [SPECIFIC PURPOSE].

I declare that the statements above are true to my personal knowledge.

Date: [__/__/____]

Signature: ______________________________

Printed name: [FULL LEGAL NAME]

Oath or affirmation

Sworn to or affirmed and subscribed before me by [AFFIANT NAME] on [__/__/____] at [PLACE].

Officer signature: ______________________________

Printed name and title: [NAME AND TITLE]

Commission details, seal, identification method, and other information required by the place of notarization: [COMPLETE AS REQUIRED]