Roommate Proof of Residency Letter Template

Date: [Date]

To (Organization/Agency): [School/DMV/Agency/Company Name]

Attn: [Department/Contact Name]

[Address/Email (if known)]

From (Writer/Roommate): [Full Name]

Role: ☐ Roommate ☐ Leaseholder ☐ Homeowner ☐ Other: [__]

Address: [Street Address, City, State, ZIP]

Phone/Email: [Contact]

1. Roommate Information

1.1 Roommate/Resident Full Name: [Resident Full Name]

1.2 Date of Birth (Optional): [DOB]

1.3 Residence 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 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 Lease status (optional): ☐ resident is on the lease ☐ resident is not on the lease ☐ unknown.

3.3 Household members (optional): [Names].

4. Supporting Documents (Optional)

4.1 Attached (if requested):

☐ Copy of lease or rental agreement showing my name/address (redact sensitive info)

☐ Utility bill in my name showing address

☐ Government mail showing my address

☐ 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

Writer/Roommate 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): ___________________