Sworn Statement
I, [Full Legal Name], of [Address], being duly sworn, do hereby declare and state under oath the following:
Full Name: [Full Legal Name]
Date of Birth: [MM/DD/YYYY]
Address: [Full Address]
Contact: [Email / Phone]
2. Purpose and Context
This sworn statement is made for the purpose of [court/administrative/financial matter]. I understand it may be reviewed by decision‑makers in New York.
3. Relationship to Parties/Events
My connection to the subject matter is: [role/relationship]. This context explains how I came to know the facts described.
4. Statement of Facts (Ordered)
I present facts in a structured, numbered list for direct reference: [1)… 2)… 3)…].
5. Records Consulted
Where I rely on documents, I identify them briefly and attach copies when helpful. I believe these records are accurate and kept in the ordinary course of activity.
If relevant, I reference messages, emails, or postings and have preserved originals where possible for verification.
7. Declarant’s Affirmation
I affirm that my statements are made honestly and in good faith based on firsthand knowledge unless otherwise indicated.
8. Oath and Penalty Statement
I declare under oath and penalty of perjury that the foregoing is true and correct.
9. Execution
Executed on [Date] at [City, State/Country].
Declarant Signature: _______________________________
Printed Name: ___________________________________
Notary / Authorized Officer Acknowledgment
On this [Day] of [Month, Year], before me, [Name of Notary/Officer], personally appeared [Declarant’s Full Name], known to me (or satisfactorily proven) to be the individual who executed the foregoing Sworn Statement, and acknowledged it to be true and correct.
Notary / Officer Signature: __________________________
Printed Name: ____________________________________
Commission No.: _________________________________
My Commission Expires: ___________________________