Affidavit of Identity

I, , of legal age, residing at , hereby declare and affirm as follows:

  1. My full legal name is:
  2. My date of birth is:
  3. I am the same person as referred to in the document(s):
  4. The details provided above are true and correct to the best of my knowledge and belief.
Date:
Signature:
Printed Name:
Notary Public: