Pennsylvania Affidavit of Identity
Pennsylvania Affidavit of Identity
STATE OF PENNSYLVANIA
COUNTY OF [County Name]
Introduction:
I, [YOUR NAME], residing at [YOUR ADDRESS], in the County of [County Name], State of Pennsylvania, being duly sworn, declare under penalty of perjury as follows:
Statement of Facts:
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I am the individual named herein.
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I am a legal resident of the State of Pennsylvania and I am presenting this affidavit as proof of my identity.
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This affidavit is made for the purpose of obtaining a replacement for my lost or stolen identification document(s).
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The following document(s) have been lost or stolen:
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[Type of Document, e.g., Pennsylvania Driver's License]
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[Type of Document, if applicable]
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Date of Loss/Theft: [Date]
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Place of Loss/Theft: [Location]
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I affirm that the information provided in this affidavit is true and accurate to the best of my knowledge.
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This affidavit is made in good faith, without any intention to deceive or commit fraud.
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Attached are copies of documents that serve as proof of my identity and residency (if applicable), including:
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[List of Documents]
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POLICE REPORT:
I have [not] filed a police report regarding the lost or stolen document(s).
[If applicable] A copy of the police report is attached.
CONTACT INFORMATION:
My current contact information is as follows:
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Phone Number: [YOUR PHONE NUMBER]
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Email Address: [YOUR EMAIL ADDRESS]
Acknowledgement:
I hereby affirm that the information provided in this affidavit is true and correct to the best of my knowledge and belief.
I understand that providing false statements in this affidavit can result in penalties under the law.
Signature:
[YOUR NAME]
Subscribed and sworn to (or affirmed) before me on this [Day] of [Month], [Year], by [YOUR NAME], proved to me on the basis of satisfactory evidence to be the person who appeared before me.
[NOTARY PUBLIC NAME]