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:

1. Affiant Information

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:

[Insert details]

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:

[Insert details]

7. Current Status of Information

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]