Sworn Statement
I, [Full Legal Name], of [Address], being duly sworn, do hereby declare and state under oath the following:
1. Identity of Declarant
Full Name: [Full Legal Name]
DOB: [MM/DD/YYYY]
Address: [Full Address]
Govt ID (if applicable): [ID / DL No.]
2. Statement Purpose
This statement is provided for [describe matter], with the intent to present clear, practical facts.
3. Factual Narrative
I set out specific facts with dates, locations, and participants as known to me: [numbered list].
4. Witnesses (if any)
Known witnesses and contact details (if available): [Name, role, phone/email].
5. Documents and Items
Supporting items include [invoices, photos, emails, logs]; I have preserved copies and can make them available on request.
6. Accuracy and Corrections
If new information arises, I will supplement or correct this statement to the extent necessary.
7. Penalty of Perjury
I swear that the foregoing is true and correct to the best of my knowledge and belief.
8. Execution Details
Executed this [Day] of [Month, Year], 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: ___________________________