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NOTARIZED PROOF OF IDENTIFICATION
PART I.
ENTER NAME, DATE AND PLACE OF BIRTH/DEATH, AND NAMES OF PARENTS AS INFORMATION APPEARS ON
BIRTH/DEATH CERTIFICATE
)8//1$0(2)PERSON ON RECORD
'$7(2)BIRTH/DEATH
3/$&(2)BIRTH/'($7+
&LW\ or County)
6(;
)8//1$0(2)PARENT 1
)8//NAME OF PARENT 2
PART II. ENTER RELATIONSHIP TO PERSON ON RECORD AND THE TYPE OF ID USED.
NAME AND RELATIONSHIP TO PERSON ON RECORD
TYPE AND NUMBER OF ID ACCEPTED WHEN NOTARIZED
AFFIDAVIT OF PERSONAL KNOWLEDGE
PART III. THIS SECTION MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC.
STATE OF
_____________________
COUNTY OF _____________________
%HIRUHPHRQWKLVGD\DSSHDUHG BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB___________BB (Name)
QRZUHVLGLQJDWBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB__________________
BB ﾤ
(Address)
(City)
(State)
who is related WRWKHSHUVRQQDPHGRQ3DUW,DVBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB___BBDQGZKR