Date: [Date]
To (Organization/Agency): [School/DMV/Agency/Company Name]
Attn: [Department/Contact Name]
[Address/Email (if known)]
From (Family Member): [Full Name]
Relationship to Resident: [Parent/Grandparent/Sibling/Spouse/Other]
Address: [Street Address, City, State, ZIP]
Phone/Email: [Contact]
1.1 Resident Full Name: [Resident Full Name]
1.2 Date of Birth (Optional): [DOB]
1.3 Residence Address Being Verified: [Same as family member address]
1.4 Date Resident Moved In (If Known): [Date]
1.5 Living Arrangement (Optional): ☐ staying temporarily ☐ living long-term ☐ other: [__]
2. Statement of Residence
2.1 I confirm that [Resident Full Name] currently lives with me at [Address].
2.2 To the best of my knowledge, the resident has lived at this address since [Move-In Date].
3. Additional Details (Optional)
3.1 The resident receives mail at this address: ☐ Yes ☐ No.
3.2 Household members (optional): [Names/relationship].
3.3 If the organization requires proof that I live at this address, I can provide the supporting documents listed below.
4. Supporting Documents (Optional)
4.1 Attached (if requested):
☐ Copy of my lease/mortgage statement (redact sensitive info if needed)
☐ Utility bill in my name
☐ Government mail showing my address
☐ Photo ID (copy)
☐ Other: [List]
5. Truthful Statement
5.1 I declare that the statements in this letter are true and correct to the best of my knowledge.
Signatures
Family Member Name: [Full Name]
Date: [Date]
Signature: ___________________________
Notary / Notarization (Optional)
State of [State]
County of [County]
On [Date], before me, [Notary Name], personally appeared [Family Member Full Name], known to me (or satisfactorily proven) to be the person whose name is subscribed to this letter, and acknowledged that they executed it for the purposes stated.
Notary Public Signature: _______________________
My Commission Expires: _______________________
Notary Seal (if applicable): ___________________