DMV PROOF OF RESIDENCY LETTER

I. APPLICANT INFORMATION

This Affidavit of Residence is made regarding the following individual applying for a driver's license or state identification card (the "Applicant"):

Full Legal Name of Applicant:

Date of Birth:

II. AFFIANT INFORMATION

I, the undersigned (the "Affiant"), being duly sworn, hereby certify that I am over the age of eighteen (18) years and competent to testify to the matters stated herein.

Full Legal Name of Affiant:

Current Residential Address:

Phone Number:

Email Address:

III. RESIDENCE DETAILS

I hereby certify and verify that the Applicant named in Section I currently resides with me or at a property I own/manage at the following address (the "Residence"):

Residence Address:

IV. RELATIONSHIP TO APPLICANT

The Affiant's relationship to the Applicant is as follows (check one):

V. RESIDENCY STATUS AND DURATION

The Applicant has resided at the Residence since the following date:

The nature of the residency arrangement is:

Additional details regarding the living arrangement are:

VI. SUPPORTING DOCUMENTATION

The Affiant understands that the Department of Motor Vehicles (DMV) may require proof of the Affiant's residency at the address listed above. The Affiant agrees to provide, or has attached hereto, copies of the following documents in the Affiant's name to support this verification (check all that apply):

VII. SWORN STATEMENT AND PENALTY OF PERJURY

I, the Affiant, declare under penalty of perjury under the laws of the State of Select StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming that the information provided in this Proof of Residency Letter is true and correct to the best of my knowledge.

I understand that providing false information on this document to the Department of Motor Vehicles may constitute a crime and may result in criminal prosecution, fines, and/or the cancellation of the Applicant's driver's license or identification card.

VIII. SIGNATURES

Affiant Signature

Signature: _________________________
Date:
Print Name: _______________

Applicant Signature (If required by State DMV)

Signature: _________________________
Date:
Print Name: _______________