COMMONWEALTH OF VIRGINIA
COUNTY OF [County Name]

Introduction:

I, [YOUR NAME], residing at [YOUR ADDRESS], in the County of [County Name], Commonwealth of Virginia, being duly sworn, do hereby affirm and state the following:

Statement of Facts:

1. I, [YOUR NAME], currently residing at [YOUR ADDRESS], hereby affirm my personal details as truthfully stated.

2. Born on [DOB], I am recognized and verified through my identification number: [Driver’s License/State ID/Passport Number].

3. This statement is intended to attest to the authenticity of my identity and residence information, ensuring accuracy for any legal, official, or verification processes that require such details.

4. I am the legal holder of the document titled [Document Title], dated [Document Date], which pertains to which pertains to my application for financial assistance from the [Name of Program or Organization].

5. I hereby affirm that to the best of my knowledge and belief, the document is authentic, and the information contained within, as well as any statements or representations made therein, are accurate and true.

Purpose of Affidavit:

This affidavit is made for the purpose of verifying the authenticity of the aforementioned document and the accuracy of its contents, intended for use in [Specify the intended use, etc.] with [Name of Institution, Agency, or Individual].

Oath and Declaration:

I understand that this affidavit is made under the penalties of perjury and declare under penalty of perjury under the laws of the Commonwealth of Virginia that the foregoing is true and correct to the best of my knowledge, information, and belief.

Executed on this [DAY] of [MONTH], [YEAR], at [City or Town], Virginia.

Signature:

[YOUR NAME]

Subscribed and sworn to (or affirmed) before me on this [DAY] of [MONTH], [YEAR], by [YOUR NAME], known to me (or satisfactorily proven) to be the person whose name is subscribed to this affidavit.

[Notary Public’s Printed Name]

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