Affidavit of Residency Template

This Affidavit of Residency (the “Affidavit”) is made on [Date] by:

Affiant: [Full Name], date of birth (optional): [DOB], phone/email: [Contact].

Current Address Being Verified: [Street Address, City, State, ZIP]

Mailing Address (If Different) (Optional): [Address]

Affiant Role (Select One):

☐ I am the person residing at the address above

☐ I am the homeowner/leaseholder confirming the resident’s address

☐ Other: [Explain]

Resident (If Affiant Is Not the Resident) (Optional):

• Resident Full Name: [Name]

• Resident DOB (Optional): [DOB]

• Relationship to Affiant: [Relationship]

Resident Full Name: [Name]

Resident DOB (Optional): [DOB]

Relationship to Affiant: [Relationship]

1. Residency Statement

1.1 I declare that:

• The residence address listed above is: ☐ my current primary residence ☐ the resident’s current primary residence.

• The residence began on or about: [Move-in Date].

• I have resided (or the resident has resided) at this address for: [__] months/years.

The residence address listed above is: ☐ my current primary residence ☐ the resident’s current primary residence.

The residence began on or about: [Move-in Date].

I have resided (or the resident has resided) at this address for: [__] months/years.

2. Prior Address (Optional)

2.1 Prior residence address (if required): [Prior Address].

2.2 Date moved from prior address: [Date].

3. Purpose (Optional)

3.1 I am providing this Affidavit for: ☐ school enrollment ☐ court filing ☐ DMV ☐ benefits ☐ housing ☐ other: [Purpose].

4. Supporting Documents (Optional)

4.1 Attached (if available):

☐ Lease/rental agreement (copy)

☐ Utility bill

☐ Bank statement

☐ Government mail

☐ Pay stub

☐ Insurance document

☐ Other: [List]

5. Statement Under Oath

5.1 I declare under penalty of perjury that the statements in this Affidavit are true and correct to the best of my knowledge.

Signatures

Affiant: [Full Name]

Date: [Date]

Signature: ___________________________

Witnesses (If Required)

Witness Name: [Name]

Date: [Date]

Signature: ___________________________

Notary / Notarization (If Required)

State of [State]

County of [County]

On [Date], before me, [Notary Name], personally appeared [Affiant Full Name], known to me (or satisfactorily proven) to be the person whose name is subscribed to this Affidavit, and acknowledged that they executed it for the purposes stated.

Notary Public Signature: _______________________

My Commission Expires: _______________________

Notary Seal (if applicable): ___________________