Introduction

I, [YOUR NAME], residing at [YOUR ADDRESS], under oath, declare that I am competent to make this affidavit.

Statement of Facts

1. I am a lawful resident of the State of Oregon and have been residing at the aforementioned address continuously for the duration of [DURATION OF RESIDENCY].

2. I maintain my primary residence at the aforementioned address, and I do not claim residency in any other state or jurisdiction for the purpose of obtaining government benefits.

3. I am applying for government benefits from the [NAME OF GOVERNMENT AGENCY/PROGRAM] based on my residency in the State of Oregon.

4. I understand that providing false information on this affidavit may result in legal consequences, including but not limited to fines, imprisonment, and disqualification from receiving government benefits.

5. I authorize the [NAME OF GOVERNMENT AGENCY/PROGRAM] to verify the information provided in this affidavit through any means deemed necessary, including but not limited to contacting relevant government agencies, financial institutions, and landlords.

Sworn Oath

I solemnly swear, under penalty of perjury, that the statements made in this affidavit are true and correct to the best of my knowledge and belief.

Executed on this [DATE] day of [MONTH], [YEAR].

[YOUR NAME]

Affiant

Notary Acknowledgment

State of Oregon

County of [COUNTY NAME]

Subscribed and sworn to before me this [DATE] day of [MONTH], [YEAR], by [YOUR NAME], proved to me based on satisfactory evidence to be the person who appeared before me.

[NOTARY STAMP]

Notary Public for Oregon

My commission expires: [COMMISSION EXPIRY DATE]

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