Free affidavit of identity 11
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Notarized Identity Verification
PRINT NAME:________________________________________________________________
(First Name, Middle Initial, Last Name)
E-mail Address (optional): ______________________________________________________

Address:____________________________________________________________________

City:________________________________ State:__________ Zip Code: _______________

I hereby represent that all above information is true and accurate.
Signature: ___________________________________________
(Sign in the Presence of a Notary)
State of _________________________

County of _______________________

I hereby certify that on this ______day of ________________________, 20___________
Personally appeared before me the signer and subject of the above form, who signed or attested
to the same in my presence, and presented the following form of identification as proof of his or
her identity:
Driver’s License or Govt. Identification Card
U.S. Passport
U.S. Military ID Card
State Id