State of Alaska
County of [County Name]

Introduction:

I, [YOUR NAME], born on [Original Date of Birth], resident of [Full Address], being duly sworn, depose and state under penalty of perjury that:

Statement of Facts:

1. I am the person named in this affidavit and have personal knowledge of the facts stated herein.

2. This affidavit is made for the purpose of correcting a discrepancy in my official records.

3. The specific discrepancy to be corrected is in my [name/birthdate] as recorded on [type of record] issued by [issuing authority].

4. The current record inaccurately lists my [name/birthdate] as [Incorrect Name/Date of Birth].

5. The correct [name/birthdate] is [Correct Name/Correct Date of Birth].

6. I have attached hereto copies of supporting documentation evidencing the correct [name/birthdate].

7. This includes [list documents].

Declaration:

I hereby affirm that the correction of the above-mentioned discrepancy will reflect my true and accurate [name/birthdate] and is not made for any fraudulent or deceitful purposes.

Indemnification:

I agree to indemnify and hold harmless any entity that relies on this affidavit for the correction of my [name/birthdate] from and against any and all claims, damages, losses, liabilities, costs, and expenses arising from this correction.

I declare under penalty of perjury under the laws of the State of Alaska that the foregoing is true and correct to the best of my knowledge, information, and belief.

Executed on this [Day] of [Month], [Year].

Notarization:

Subscribed and sworn to (or affirmed) before me this [Day] of [Month], [Year], by [YOUR NAME], proved to me on the basis of satisfactory evidence to be the person who appeared before me.

Signature:

[YOUR NAME]

[NOTARY PUBLIC NAME]

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