Affidavit of Beneficial Ownership
I. Introduction
This Affidavit of Beneficial Ownership is executed by the undersigned affiant to confirm the details regarding the beneficial ownership of certain assets or accounts. The information provided herein is truthful, accurate, and complete to the best knowledge of the affiant.
II. Affiant Information
A. Personal Details
Full Name: [YOUR NAME]
Date of Birth: August 8, 2030
Address:Indianapolis, IN 46201
Contact Number: 222 555 7777
B. Identification
Government Issued ID Type: Driver's License
ID Number: 184752
Issuing Authority: Indiana
Date of Issue: February 1, 2066
Date of Expiry: March 1, 2071
III. Asset/Account Details
Details of the asset or account beneficially owned by the affiant are provided below:
A. Asset/Account Description
Type of Asset/Account: Bank Account
Account Number (if applicable): 1234567890
Location of Asset/Account: Bank of America, 123 Main Street, Phoenix, AZ 85001
B. Ownership Details
IV. Declaration
I, the undersigned, hereby declare under the penalty of perjury that the information provided in this Affidavit of Beneficial Ownership is true and correct. I understand that providing false or misleading information may result in legal consequences.
V. Signature
[YOUR NAME]
Affiant
Notary Public
My commission expires: September 15, 2088
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