Notarized Affidavit
State of [STATE NAME]
County of [COUNTY NAME]
Date: September 25, 2050
Affiant:
I, Lawrence Orn, of Atlanta, GA 30301, being duly sworn, do hereby declare and affirm the following:
Statement of Facts:
Identity Information:
Full Name: Lawrence Orn
Date of Birth: July 15, 2005
Social Security Number: 123-45-6789
Driver's License Number: D1234567
Residency Information:
Affirmation of Identity: I affirm that I am the individual named above and that the information provided in this affidavit is accurate to the best of my knowledge. I acknowledge that this affidavit is being provided to verify my personal identity and residency for legal or administrative purposes.
Affirmation of Residency: I affirm that I reside at the address provided above and have resided there for the period specified.
Oath or Affirmation:
I hereby swear or affirm under the penalty of perjury that the statements contained in this affidavit are true and correct to the best of my knowledge, belief, and understanding.
Signature of Affiant:
Lawrence Orn
Notarial Certificate:
State of [STATE NAME]
County of [COUNTY NAME]
On this 25th day of September, 2050, before me, the undersigned notary public, personally appeared Lawrence Orn, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within affidavit, and acknowledged that he executed the same for the purposes therein contained.
In witness whereof, I hereunto set my hand and official seal.
[YOUR NAME]
Notary Public
My Commission Expires: March 12, 2055
[Notary Seal]
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