Montana Affidavit of Residence
Montana Affidavit of Residence
STATE OF MONTANA
COUNTY OF [County Name]
Introduction:
I, [YOUR NAME], being duly sworn, depose and state:
Statement of Facts:
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I, [YOUR NAME], born on [Date of Birth], hereby declare under oath my personal details necessary for the Montana Affidavit of Residence.
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My Social Security Number is [SSN], although provision of this number may be optional depending on the specific requirements of the state health program or social service for which this affidavit is being submitted.
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I am currently residing at [YOUR ADDRESS], a place I consider my permanent home within the State of Montana.
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For any necessary correspondence or verification processes, I can be contacted at my telephone number, [YOUR PHONE NUMBER], or via my email address, [YOUR EMAIL ADDRESS].
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This information is provided in good faith to establish my residency status in Montana for the purpose of qualifying for state health programs or social services exclusive to Montana residents.
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I hereby declare that I am a resident of the State of Montana, residing at the above-mentioned address within the county of [County Name].
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I have been living at this address since [Date of Residency Start].
Purpose of Affidavit:
This affidavit is made for the purpose of qualifying for state health programs or social services available exclusively to residents of the State of Montana.
Supporting Evidence:
Attached hereto are copies of documents that serve as evidence of my residency:
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Lease Agreement
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Utility Bill
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Montana Driver’s License
Oath and Affirmation:
I affirm that the information provided in this affidavit is true and correct to the best of my knowledge.
I understand that providing false information on this affidavit can result in penalties under law.
Signed this [DAY] of [MONTH], [YEAR].
Signature:
[YOUR NAME]
Subscribed and sworn to (or affirmed) before me this [DAY] of [MONTH], [YEAR], by [YOUR NAME], who is personally known to me or has produced valid driver's license as identification.
[NOTARY PUBLIC NAME]