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Affidavit of Residency Template
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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]
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.
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): ___________________
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Affidavit of Residency Template
AFFIDAVIT OF RESIDENCY TEMPLATE FAQ
What is an affidavit of residency?
An Affidavit of Residency is a sworn statement confirming where you live. It’s often used for school enrollment, court filings, DMV matters, benefits programs, or housing verification when an agency requires an affidavit rather than a simple letter.
Who can sign it?
Usually the person who lives at the address signs it. In some cases, a homeowner/leaseholder or another adult with personal knowledge can sign as the affiant. This template includes both options.
What should be included?
Include your full name, the address being verified, how long you’ve lived there, and a statement that the information is true under penalty of perjury. This template also includes an attachments list for supporting documents.
Do you need notarization?
Often yes. Many affidavits must be notarized to be accepted. This template includes a notarization block and an optional witness section.
Can this be used in court?
Sometimes, but courts may require specific local forms or additional proof. This template is a general affidavit you can adapt to match local requirements.
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