Affidavit of Identity Template
State of [State]
County of [County]
Before me, the undersigned authority, personally appeared [Affiant Full Name], who, being duly sworn, states as follows:
Affiant Name: [Full Legal Name]
Other Name(s) Used, if any: [Former Name / Maiden Name / Alias / Other]
Date of Birth: [Date of Birth]
Address: [Current Address]
City, State, ZIP Code: [City, State, ZIP Code]
Phone Number: [Phone Number]
Email Address: [Email Address]
2. Purpose of Affidavit
I make this Affidavit of Identity for the purpose of confirming my identity in connection with the following matter:
[Describe transaction, application, account, filing, property matter, court matter, or other purpose]
3. Identity Statement
I state that I am the same person as:
[Name exactly as shown on the relevant account, document, application, or record]
If my name appears differently on another record, document, or identification, the variation is as follows:
[Describe name variation]
4. Personal Identifying Details
The following identifying details apply to me:
Date of Birth: [Date of Birth]
Place of Birth, if needed: [City, State / Country]
Last Four Digits of SSN, if appropriate: [XXXX]
Driver’s License / State ID Number, if applicable: [Number]
Passport Number, if applicable: [Number]
Additional identifying details, if any:
[Insert details]
5. Supporting Identification
I am providing or relying on the following identification document or documents in support of this affidavit:
☐ driver’s license
☐ state identification card
☐ passport
☐ military identification
☐ permanent resident card
☐ other: [Describe]
Identification document details:
Issuing Authority: [Agency / State / Country]
Document Number: [Number]
Expiration Date: [Date]
If more than one document is being used, list additional details here:
6. Name History or Identity Clarification
If applicable, I further state the following regarding my identity, prior names, or related records:
☐ I previously used the following name: [Name]
☐ my name changed because of marriage, divorce, court order, or other reason: [Describe]
☐ the person named in the referenced record and I are the same person
☐ other clarification: [Describe]
Additional explanation:
To the best of my knowledge, the identity information stated in this affidavit is true and correct.
I further state that I am making this affidavit voluntarily and for the purpose described above.
8. Attached Documents
The following documents are attached or available in support of this affidavit, if needed:
☐ copy of identification document
☐ proof of address
☐ certified name-change record
☐ marriage certificate
☐ divorce decree
☐ court order
☐ other: [Describe]
9. Reliance on Affidavit
I understand that this affidavit may be relied upon by:
[Name of institution, company, agency, court, or other recipient]
for identity-verification purposes connected to the matter described above.
10. Certification
I certify under penalty of perjury that the statements in this Affidavit of Identity are true and correct to the best of my knowledge and belief.
11. Signature
Affiant Signature: __________________________
Name: [Full Legal Name]
Date: [Date]
12. Notary Acknowledgment
Subscribed and sworn to before me on this [Day] of [Month], [Year], by [Affiant Full Name].
Notary Public Signature: __________________________
Name: [Notary Name]
My Commission Expires: [Date]
13. Optional Witness Section
Witness Signature, if needed: __________________________
Name: [Full Name]
Date: [Date]
Second Witness Signature, if needed: __________________________
Name: [Full Name]
Date: [Date]