STATE OF MICHIGAN
COUNTY OF [COUNTY NAME]

Introduction:

I, [YOUR NAME], being duly sworn, declare and affirm under the penalties of perjury:

Statement of Facts:

1. I, [YOUR NAME], born on [Date of Birth], hereby provide my personal details as part of this affidavit.

2. While the provision of my Social Security Number is optional, I have chosen to include it/not include it for identification purposes.

3. I hold a Michigan Driver's License/State ID, numbered [License/ID Number], as proof of my identity and residency within the state.

4. My current place of residence is listed as [YOUR ADDRESS], which serves as my domicile within the jurisdiction of this affidavit.

5. For further communication, I can be contacted at my telephone number, [YOUR TELEPHONE NUMBER], and through my email address, [YOUR EMAIL ADDRESS].

6. I hereby affirm that I have been a continuous resident of the State of Michigan for at least the twelve (12) months immediately preceding the date of this affidavit.

7. I have established and maintained a bona fide domicile in Michigan primarily for purposes other than educational.

8. I affirm that my presence in Michigan is not primarily for educational purposes but to establish a permanent domicile.

9. I intend to make Michigan my permanent home and have relinquished residency in any other state.

Supporting Documents:

• Utility Bill, [Date]

• Michigan Driver’s License, [Date]

• Michigan Voter Registration, [Date]
  

Declaration:

I understand that providing false information on this affidavit and any attached documents is grounds for penalties, including but not limited to the revocation of in-state tuition status and disciplinary action by [University/College Name].

Sworn to (or affirmed) and subscribed before me this [Day] of [Month], [Year].

Signature:

[YOUR NAME]

[NOTARY PUBLIC NAME]

Affidavit Templates @ Template.net