Free affidavit of identity 14Free affidavit of identity 14
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UNCLAIMED COOGAN FUNDS HELD BY THE ACTORS FUND OF AMERICA

AFFIDAVIT OF PROOF OF IDENTITY
This form must be notarized. It will be used to authenticate your identity and verify your
signature.
I, the Affiant herein, being first duly sworn upon oath, does hereby state:
1. That my legal name is ___________________________________________________________________
2. That my U.S. Government number (SSN or ITIN) is
___________________________________________
3. That my current Physical Address is (cannot be a PO Box)
______________________________________
_______________________________________________________________________________________
4. That my date of birth is
___________________________________________________________________
5. That I presented to my Notary Public, as proof of my identity, a valid state/US
government issued Photo ID.
Type:  Drivers License
 Identification Card
 Other (please
describe)____________________
Issued in the State of: _________________________ (require