Date: [Date]
To (Organization/Agency): [School/DMV/Agency/Company Name]
Attn: [Department/Contact Name]
[Address/Email (if known)]
From (Writer): [Full Name]
Relationship to Resident: ☐ Landlord ☐ Property manager ☐ Roommate ☐ Family member ☐ Employer ☐ Other: [Explain]
Address: [Writer Address]
Phone/Email: [Contact]
1.1 Resident Full Name: [Resident Full Name]
1.2 Date of Birth (Optional): [DOB]
1.3 Address Being Verified: [Street Address, City, State, ZIP]
1.4 Unit/Apt (If Applicable): [Unit/Apt #]
1.5 Move-In Date (If Known): [Date]
2. Statement of Residency
2.1 I confirm that [Resident Full Name] currently resides at [Verified Address].
2.2 I know this to be true because:
☐ I am the landlord/property manager for the residence
☐ I live at the residence and share the household
☐ I regularly receive or observe mail/deliveries for the resident at this address
☐ Other basis of knowledge: [Explain briefly]
3. Additional Details (Optional)
3.1 Lease/Arrangement (Optional): ☐ Lease ☐ Sublease ☐ Informal arrangement ☐ Other: [__].
3.2 Household/Occupancy (Optional): [Resident lives alone / with family / with roommates].
3.3 Resident Contact (Optional): [Phone/Email].
4. Supporting Documents (Optional)
4.1 Attached (if applicable):
☐ Copy of lease/rental agreement (redact sensitive info if needed)
☐ Utility bill showing address
☐ Bank statement showing address
☐ Government mail showing address
☐ Other: [List]
5.1 I am willing to confirm this information if contacted by the organization above.
5.2 Best contact method/time: [Phone/email + hours].
6. Truthful Statement
6.1 I declare that the statements in this letter are true and correct to the best of my knowledge.
Signatures
Writer Name: [Full Name]
Date: [Date]
Signature: ___________________________
Notary / Notarization (Optional)
State of [State]
County of [County]
On [Date], before me, [Notary Name], personally appeared [Writer 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): ___________________