EMPLOYER PROOF OF RESIDENCY LETTER

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COUNTY OF

I. EMPLOYER / COMPANY INFORMATION

This verification is being completed by the following authorized representative of the Employer:

Company Name:
Company Address:

Representative Name:
Representative Title:
Business Phone:
Business Email:

II. EMPLOYEE INFORMATION

The individual for whom residency is being verified is:

Employee Name:
Employee ID / Reference Number:
Job Title:

III. VERIFIED RESIDENTIAL ADDRESS

The Employer hereby verifies that the Employee maintains their primary residence at the following physical location. This address is recorded in the Employer’s personnel files and has been verified according to company procedures and applicable regulatory requirements.

Address:

IV. METHOD OF VERIFICATION

The Employer has verified the residency of the Employee based on the following documentation or methods (check all that apply):

V. EMPLOYMENT STATUS

Current Employment Status of the Employee (check one):

Date of Hire:

VI. ADDITIONAL COMMENTS

Any additional notes or context regarding the verification of this address:

VII. CERTIFICATION AND SWORN STATEMENT

I, the undersigned Authorized Representative, being duly sworn, depose and state that:

1. I am an authorized agent of the Employer listed in Section I and have the authority to execute this document on its behalf.

2. I have personally reviewed the records and/or documentation regarding the Employee named in Section II.

3. The information provided in this Affidavit regarding the Employee's residential address is true, correct, and complete to the best of my knowledge and belief based on the records maintained by the Employer.

4. This verification is provided for the purpose of compliance with legal, regulatory, or administrative requirements.

5. I understand that providing false or misleading information on this document may result in legal consequences, including penalties for perjury.

VIII. SIGNATURE OF AUTHORIZED REPRESENTATIVE

Signature: _________________________
Date:

Print Name: _______________
Title: _______________