Simple Name Verification Affidavit

I. Affiant Information

1. Name: Jean Harris

2. Address: Indianapolis, IN 46201

3. Contact Information:

• Phone Number: 222 555 7777

• Email Address: jean@you.mail

II. Purpose of Affidavit

This affidavit serves to verify the true and correct usage of my name, as it appears on various documents. This statement is made to affirm the validity and current usage of my name for official, legal, and administrative purposes.

III. Declaration of Name

A. Current Legal Name

The current legal name that I use and is recognized on official documents is:

Name: Jean Harris

B. Previous Names (if applicable)

Please list any previous names used:

• ____________________________

• ____________________________

• ____________________________

IV. Supporting Information

The following documents are attached as evidence of my name verification:

• Government-issued Identification (e.g., Passport, Driver's License)

• Birth Certificate

• Certificate of Name Change (if applicable)

• Social Security Card

V. Affirmation and Signature

I, the undersigned, do hereby certify under penalty of perjury that the information provided in this affidavit is true and correct to the best of my knowledge and belief. I understand that providing false information may result in legal consequences.

Jean Harris

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