Indiana Affidavit of Residency
This Affidavit of Residency is executed pursuant to the laws of the State of Indiana to affirm the residency status of the undersigned.
Affiant Information:
- Name: ______________________________
- Address: ____________________________
- City: _______________________________
- State: Indiana
- Zip Code: __________________________
- Date of Birth: _______________________
Statement of Residency:
The undersigned, Name: ______________________________, hereby affirms that they reside at the address stated above in the State of Indiana.
This affidavit is executed for the following purpose(s):
- Verification of residency for educational purposes.
- Verification of residency for government services.
- Other: ________________________________.
Affirmation:
I declare under penalty of perjury that the foregoing is true and correct to the best of my knowledge.
Signature:
_______________________________
Date: _________________________
Notary Public Information:
State of Indiana
County of ______________________
Subscribed and sworn to before me on this ___ day of __________, 20__.
Notary Public Signature: __________________________
My Commission Expires: __________________________