Legal Residential Affidavit

LEGAL RESIDENTIAL AFFIDAVIT

Affiant Name:    Affiant Current Address:

Requesting Party Name:    Requesting Party Contact:

RECITALS

WHEREAS, the Affiant is a natural person residing at the residential premises described below and makes this affidavit for the purpose of establishing residence, occupancy, and related facts to the Requesting Party; and

WHEREAS, the Requesting Party has requested a sworn statement from the Affiant concerning the Affiant's residency, occupancy dates, and proof of tenancy or ownership for administrative, lending, benefits, or other lawful purposes; and

WHEREAS, the Affiant declares that the statements herein are based on personal knowledge, or, where indicated, on documents attached and identified below.

NOW, THEREFORE

The Affiant hereby certifies and states under penalty of perjury as follows:

1. SUBJECT PROPERTY

The residential premises for which this affidavit is given are located at:

2. OCCUPANCY

Affiant occupied the subject property from until (if still residing, enter present date in the "until" fields).

3. BASIS OF OCCUPANCY

Check all that apply and provide details where requested. The Affiant affirms that the following statements are true to the best of Affiant's knowledge.

Owner of record    Tenant under written lease    Subtenant / occupant with permission    Other (describe below)

4. DOCUMENTARY PROOF

Affiant attaches or will produce the following supporting documents to corroborate the statements made herein. Check all that apply.

Copy of lease or rental agreement    Recent utility bill in Affiant's name    Government-issued identification

5. AFFIANT'S STATEMENT AND ATTESTATION

The Affiant affirms, under penalty of perjury, that Affiant currently resides at the subject property or resided there during the period stated above; that the facts set forth in this affidavit are true and correct to the best of Affiant's knowledge and belief; and that Affiant understands that knowingly making a false statement in this affidavit may subject Affiant to civil or criminal penalties under applicable law.

6. AUTHORIZATION TO RELEASE INFORMATION

Affiant authorizes owners, landlords, property managers, utility companies, or governmental agencies to release records and information concerning Affiant's tenancy or residency to the Requesting Party for the purpose of verifying the statements herein. This authorization is limited to information reasonably necessary to verify residency or occupancy.

7. REPRESENTATIONS, WARRANTIES AND INDEMNITY

Affiant represents and warrants that Affiant has the authority to make the statements contained in this affidavit. Affiant agrees to indemnify and hold harmless the Requesting Party against any third-party claims arising from Affiant's misrepresentation or failure to disclose material facts known to Affiant at the time of execution.

8. NOTICES

All notices required or permitted under this affidavit shall be in writing and delivered to the addresses provided in the opening paragraph by personal delivery, certified mail, or other commercially reasonable means. Notice is effective upon receipt.

9. AMENDMENTS; WAIVER; COUNTERPARTS

This affidavit may be amended only by a written instrument signed by both parties. No waiver of any provision of this affidavit will be effective unless in writing and signed by the party against whom enforcement is sought. This affidavit may be executed in counterparts, each of which shall be deemed an original and together shall constitute one instrument.

10. GOVERNING LAW; ENTIRE AGREEMENT; SEVERABILITY

This affidavit is governed by the substantive laws of the state in which the subject property is located, without regard to conflicts of law principles. This affidavit constitutes the entire agreement between the parties with respect to the subject matter herein and supersedes all prior statements, agreements or understandings, whether written or oral. If any provision of this affidavit is held invalid or unenforceable, the remaining provisions will remain in full force and effect.

JURAT

I declare under penalty of perjury under the laws of the State in which the subject property is located that the foregoing is true and correct.

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