Affidavit of Relationship

State of
County of

I, , being duly sworn, do hereby make this affidavit and state as follows:

1. Affiant Information

Full Name
Address
Date of Birth
Relationship to Subject

2. Subject Information

Full Name
Address
Date of Birth
Relationship to Affiant

3. Statement of Relationship

4. Additional Facts (if any)

I affirm that the foregoing is true and correct to the best of my knowledge and belief.

Affiant's Signature
Printed Name
Date
Subscribed and sworn to before me this day of , 20
Notary Public