Fill and Sign the Affidavit Residency Form

Affidavit of Residency State of __________________________ County of ________________________ ______________________ (Name of Affiant) , being first duly sworn, depose and say: I, the undersigned Affiant, reside at __________________________________________ __________________________________ (street address, city, state, zip code) , and have for a period of at least ___________________ (e.g. years, months, etc) prior to the date of this Affidavit been a resident at said address. Prior to residing at this address, I resided at the following address for the dates shown: 1. ____________________________________________________ (street address, city, state, zip code) from _______________ (date) to ________________ (date) ; 2. ____________________________________________________ (street address, city, state, zip code) from _______________ (date) to ________________ (date) ; and 3. ____________________________________________________ (street address, city, state, zip code) from _______________ (date) to ________________ (date) . This Affidavit is made to (reason for affidavit) ________________________________ ____________________________________________________________________________ ____________________________________________________________________________ . ________________________________ (Signature of Affiant) ________________________________ (Print or Type Name) SWORN to and subscribed before me, this the ______ day of ________________, 20______. __________________________ NOTARY PUBLIC My Commission Expires: _______________________