Free affidavit of identity 30
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STATE OF _____________________)

Claim Number __________________

COUNTY OF ___________________)
BEFORE ME, this day, personally appeared (1)_________________________________
and (2)_________________________________, who, being first duly sworn, state as follows:
1. We are submitting this sworn statement in connection with the unclaimed property claim filed by
_____________________________________(hereinafter Claimant). We have personal knowledge of Claimant, are
familiar with the circumstances of Claimant, personally know and have personally observed Claimant, have
experience in dealing with Claimant on a daily basis or as a family member, and know Claimant to be the person
named as Claimant in the claim documents. The address of Claimant is ___________________________________
2. It is our belief that Claimant does not possess a driver’s license or o