Introduction

I, [YOUR NAME], residing at [YOUR ADDRESS], City of [CITY NAME], State of Wisconsin, do hereby solemnly affirm and declare under penalty of perjury, pursuant to the laws of the State of Wisconsin, that the following statements are true and correct to the best of my knowledge and belief:

Statements

1. I am a legal resident of the State of Wisconsin, and my primary residence is located at the address mentioned above.

2. I have resided at the aforementioned address continuously for the duration specified below:

   • Start Date of Residency: [DATE]

3. I understand that this Affidavit of Residence is being submitted in support of my application for government benefits in the State of Wisconsin.

4. I further understand that government agencies may rely on the information contained in this affidavit for the purpose of determining my eligibility for benefits, and I authorize them to verify the information provided herein through appropriate means.

Sworn Oath

I, [YOUR NAME], certify that the information provided herein is accurate and complete, and I acknowledge that providing false information may result in legal consequences, including but not limited to prosecution for perjury.

IN WITNESS WHEREOF, I have hereunto set my hand and seal on this [DATE].

Signature

[YOUR NAME]

Sworn to and subscribed before me this [DATE].

[NOTARY PUBLIC'S NAME]

Notary Public

[COMMISSION EXPIRY DATE]

Please ensure that you sign the affidavit in the presence of a notary public or other authorized official.

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