Montana Affidavit of Residence

STATE OF MONTANA

COUNTY OF [County Name]

Introduction:

I, [YOUR NAME], being duly sworn, depose and state:

Statement of Facts:

I, [YOUR NAME], born on [Date of Birth], hereby declare under oath my personal details necessary for the Montana Affidavit of Residence.
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.
I am currently residing at [YOUR ADDRESS], a place I consider my permanent home within the State of Montana.
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].
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.
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].
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:

Lease Agreement
Utility Bill
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]