Indiana Affidavit of Residency
This Affidavit of Residency is executed in accordance with the laws of the state of Indiana. It serves as a declaration of residency for the individual named below.
Affiant Information:
- Full Name: _______________________________________________
- Address: _______________________________________________
- City, State, Zip Code: ________________________________
- Date of Birth: __________________________________________
- Phone Number: _________________________________________
Declaration:
I, the undersigned, declare under penalty of perjury that I am a resident of the address provided above. I have lived at this residence since:
Residency Start Date: ______________________________________
I affirm that this information is true and accurate to the best of my knowledge and belief.
Signature: _______________________________________________
Date: _________________________________________________
Notary Public Use Only:
Subscribed and sworn to before me on this ________ day of __________, 20___.
Notary Public Signature: __________________________________
My Commission Expires: _________________________________