Name Affidavit Pdf

This Name Affidavit must be signed in the presence of a advocate commissioner/notary or a S. Form I-864 03/06/18. PROOF OF DEATH AND HEIRSHIP AFFIDAVIT. Name of Child - First, Middle, Last (As it appears on birth certificate) Date of Birth - (Month, Day, Year). Affidavit of Service on Petition for Name Change and Notice of Hearing (Minor) RTF PDF General Civil Case Information Sheet RTF PDF. This person should be a disinterested (non-family member) party in a position to know the facts. Affidavit Of Parentage. Affidavit of support - The sample is used in immigration matters to prove a visa applicant won't need government financial assistance. Identification Name of Amateur / Non TC’d builder Model Serial Number Class (airplane, rotorcraft, glider, weight shift control, powered-parachute, etc. Affidavit of Title. Recovering from identity theft is a process. Name Change Affidavit. The within named person (Affiant), _____, who is a resident of_____ County, State of _____, personally came and appeared before me, the undersigned Notary Public, and makes this his/her statement, testimony and General Affidavit under oath or affirmation, in good faith, and under penalty of perjury, of sincere belief and personal knowledge that the following matters, facts, and. Self-Certification Affidavit (please print) Name of Driver: North Dakota Drivers License Number: Driver’s Phone Number: Note: Only Class A, B, or C drivers that check the first (Category 1) self-certification box below must submit a copy of their medical certificate with this affidavit. Republic of the Philippines ) Camiling, Tarlac ) S. This is only for those that have died with less than $5,000 to $150,000 (maximum depends on the State) total to their name. (This signature must exactly match signatures on all Closing Documents. § 13-10-91, stating affirmatively that the individual, firm or corporation which is engaged in the physical performance of services on behalf of. BEFORE ME, the undersigned authority, a duly qualified and commissioned Notary. Consult an attorney for more information or advice. Tennessee Name Affidavit Forms. This form, along with the title or transferable registration properly completed. (Signature of Next of Kin) (Notary Public) My Commission Expires (Signature of Next of Kin) (Signature of Next of Kin) SEAL. Caption of the case must be stated at the top of the document if it will be submitted in court. , or I/II/III/IV to your name ADDING A CO-OWNER TO A CURRENT ACCOUNT:. Planning Staff will contact you with a determination if the space in question is considered a UDU. If you need extra space to complete this section, use the space provided in. Before completing this form: 1. Affidavit - Facts Relating to Title to Real Estate PDF. The Affidavit of Identity is used to authenticate your identity and verify your signature. Make sure you mark each attached document with the correct Exhibit letter. This affidavit must be completed by the Reporting Organization and notarized. Before me, the undersigned authority, this day personally appeared _____ ("Affiant") who being by me first duly sworn, affirmed as follows:. I understand that by signing this affidavit I will not be eligible for compensation under the South Dakota Workers’ Compensation Law. This form, along with the title or transferable registration properly completed. APPLICATION TO USE BIRTH AFFIDAVIT. See Also - Change of Name complete process and Download Name change affidavit PDF here. This affidavit cannot be used to add a parent to a birth certificate (use Acknowledgment of Parentage form DOH 422-159). Middle Name Sponsor's Mailing Address 3. The individual provides with this affidavit a current Certificate of Good Standing for a reinsurance intermediary. Instructions for completing Manufacturer’s Affidavit: The Manufacturer’s Affidavit is to be filled out by a party knowledgeable of the Manufacturing of the commodity, or who can access the Manufacturing records. 700 West State Street, PO Box 83720. Instructions for completion. Planning Staff will contact you with a determination if the space in question is considered a UDU. CHILD’S NAME. Section 3 lists the forms you need for the procedure (forms are attached). Force number/Rank/Name - print. com Health care coverage is important for everyone. CLAIM INFORMATION AFFIDAVIT. A surviving spouse may title the vehicle in his or her name only by submitting a title application in the spouse’s name (no fee is required if at the time of death, the deceased was a Maine resident and the vehicle was registered and titled in Maine), the vehicle’s title, and this form completed by the spouse. Please type in the required information, print, sign and mail to the appropriate address. o Make 2 copies of your original Affidavit, including all Exhibits (total of 3 with the original). CONTRACTOR’S FINAL AFFIDAVIT STATE OF FLORIDA COUNTY OF _____ BEFORE ME, the undersigned authority, personally appeared, (contractors personal name) who after being duly sworn, deposes and says: 1. The Affidavit of Identity is used to authenticate your identity and verify your signature. If any of the heirs listed in the Small Estate Affidavit are minors, their natural guardian (called a tutor in Louisiana) can sign the Small Estate Affidavit on behalf of the minor heirs. Boise, Idaho 83720-0063. Do not leave any category blank. Form T-227 (Rev. aopc 312-08 (a) commonwealth of pennsylvania plaintiff: name and address section 8 tenant’s supersedeas affidavit filed pursuant to pa. VERIFICATION: Despondent Verified that the contents of this affidavit are true and correct to the best of my knowledge and belief and nothing has been concealed therein. 1) Name differences on Legal Documents 2) Certificate of Current Standing -Previously Registered. A sample blank affidavit form is what you would need to make an affidavit for any purpose. Affiant is one and the same person as: 2. Provide the name of the registrant(s), their address(es), their document number(s) as registered with the Division of Corporations, and the Federal Employer Identification (FEI) number. Request to Limit the Scope of Licensure as a Non-Resident Independent Adjuster. Small estate affidavit - Also referred to as a statement of heirship, it's used to avoid formal probate and to distribute the assets of a deceased person with an estate under certain dollar amounts. Plaintiff/Petitioner 1 Judge v. € Mailing Address Street Number and Name (Include Apartment Number) This I-864 is from: Reviewer. If the affidavit is a sworn statement, be sure to include the name and address of the person giving the testimony (the affiant) in the title (e. A General Affidavit allows the person making the statement (known as the Declarant) to make certain statements under oath and in writing. An Affidavit is a statement of facts made under oath. (IF APPLICABLE). That during the last ten years, I have used or have been addressed by the following names in the jurisdiction(s) and on the dates. Please remember the law is always changing. Blank affidavit form is a term used for general affidavit that you can use to create any type of affidavit including birth affidavit, affidavit of name change, affidavit of death, affidavit of residence, affidavit of domicile affidavit of heirship, small estate affidavit and affidavit of financial support. Form 76-903-17-8-1-000 (Rev. For instance, affidavit pertaining to income tax proceedings, affidavit for amending wealth tax proceedings, affidavit for the change of name after marriage, affidavit for the application of duplicate license etc. This Name Affidavit must be signed in the presence of a notary, justice of the peace or commissioner for affidavits. The name affidavit may include maiden name, married name, other names used, and all variations of the names that appear in other documents. 39-16-702) Yo, quien subscribe, presto el debido juramento de acuerdo con la ley, que nunca me ha sido emitido, por parte del Gobierno de los Estados Unidos, un Número de Social Security (previsión. (This Affidavit may be signed and attested in presence of a Magistrate/Notary/Consular Officer) Title Change in Appearance Affidavit - Indian Passport Service. Affidavit - Facts Relating to Title to Real Estate PDF. ZIP Code Postal Code Province Country StreetNumber andName Apt. This affidavit has been made in connection with the desire of the aforesaid child to secure a license to drive; mI a e are willing to assume the obligation imposed by Section 286-112(b), HRS, “Any negligence or W misconduct of a minor under the age of eighteen years when driving a motor vehicle upon a highway shall be imputed to. Affidavit of Heirship for a Motor Vehicle Information The section is for informational purposes only. MY NAME CHANGE AFFIDAVIT Date: _____ To the Town Clerk of Kindly change my name on my birth certificate to reflect the name change. Homeownership Programs Division. Small Estate Affidavit Used by Executor. 1) Name differences on Legal Documents 2) Certificate of Current Standing -Previously Registered. "My name is and I am ONE AND THE SAME PERSON AS: I hereby affirm that the information given above is true and correct to the best of my knowledge and belief, that I have been known by the present and former names as stated above, and that I am one and the same person. State government websites often end in. The Affidavit Forms Combo Package includes all of our affidavit forms in one convenient discounted package Name Affidavits These forms allow someone to declare under oath that they are the same person as another name. I am sponsoring the principal immigrant named in. owner name: This Affidavit must be completed by a third disinterested party (Affiant) who will not benefit from the decedent's estate. pdf: Certification of School Safety Class Completion: LTC-95. FLORIDA INSURANCE AFFIDAVIT Under penalty of perjury, I _____ certify that I have (Name of Insured) Personal Injury Protection, Property Damage Liability, and, when required, Bodily Injury Liability. statute 205. It comes from a past tense form of the Latin verb affidare, meaning “to pledge”; in Latin, affidavit translates to “he or she has made a pledge. 5 (commencing with Section 6550) of Division 11 of the California Family Code. If both parents are listed on the birth record and the child's name is being changed, both parents must sign the affidavit. AFFIDAVIT OF NO OTHER SOURCES OF INSURANCE State of:_____ County of:_____ I, _____ of full age, being duly sworn according to law, on his/her oath says: 1. 023, all businesses must file for a fictitious name (forms available for filing in our office or you may go to www. I have not published in the Gazette for change of name. a Solicitor or Commissioner for Oaths. ,provide your. If you served the Affidavit (Form 34). IN WITNESS WHEREOF, I hereby affix my signature this _____ day of. Click on the file name of the document you are uploading. However, even if the person wishes to change his or her name, it is required to have a more valid reason to change your name. Final determination of the name(s) to be shown in the U. AFFIDAVIT OF IDENTITY - FICTITIOUS BUSINESS NAME STATEMENT If submitting the Fictitious Business Name Statement by MAIL or through a THIRD PARTY, the registered owner MUST bring this page to a notary to be NOTARIZED. That it is the desire of the next of kin that said vehicle be assigned and registered in the name of SUBSCRIBED AND SWORN TO BEFORE ME. Understanding what are probably the two most frequent uses for the form helps to jog my memory as to their importance, and. Here it becomes a little bit more complex for both the notary, and the affiant. Affidavit of support - The sample is used in immigration matters to prove a visa applicant won't need government financial assistance. Here’s step-by-step advice that can help you limit the damage, report identity theft, and fix your credit. Indicate in A or B if the commodity was wholly Manufactured or substantially transformed by the Manufacturer. Pre-License Course Exam Proctor Affidavit Student / Licensee Name and Certification Name of Exam _____ Date & Time of Exam Completion _____. FOR THE FOLLOWING CHANGES, PROVIDE SVEC WITH A COPY OF YOUR SOCIAL SECURITY CARD AND DRIVER’S LICENSE: To correct the existing spelling of your name To correct or add a middle initial To add Jr. the same or similar name and have never resided or conducted business at the premises indicated against the judgment debtors. (1) One is an "Affidavit under penalty of perjury" that the Declarant (i. affidavit to amend a record _____ no erasures, whiteouts, photocopies, _____ state file number. I am submitting a. : BORROWER: THIS IS TO CERTIFY THAT MY LEGAL SIGNATURE IS AS WRITTEN AND TYPED BELOW. Claiming the Personal Property of Someone Who Has Died Do-It-Yourself Affidavit Procedure for Small Estates How do I use this? This packet has four parts. JDF 205 R10/15 MOTION TO FILE WITHOUT PAYMENT OR FILING FEE AND SUPPORTING FINANCIAL AFFIDAVIT MOTION TO FILE WITHOUT PAYMENT SUPPORTING FINANCIAL AFFIDAVIT, AND SUPPORTING DOCUMENTATION REQUESTED General Information It is important that you accurately complete all sections of this form as appropriate based on your personal circumstances. Affidavit of Other Party’s Earnings Page 1 of 3 Name Address City, State, Zip Phone Email IN THE _____ JUDICIAL DISTRICT COURT. An Affidavit can be created for various purposes such as Affidavit of Birth, Affidavit of Name Change, Affidavit of Heirship, Affidavit of Small Estate etc. State government websites often end in. List percentage of ownership acquired next to each name. It's a legal document the provides information known personally to the person signing. "Under oath" means to make a formal promise to be used in a court or by another official institution (such as a bank) that confirms the information included in your statement is true and based on personal knowledge or belief. will own and operate the business known as. Section 11. AFFIDAVIT OF NO OTHER SOURCES OF INSURANCE State of:_____ County of:_____ I, _____ of full age, being duly sworn according to law, on his/her oath says: 1. Establishment Name: License No. Company Name (if applicable) Mailing Address (Where the title will be mailed) City State Zip Code Email Address Phone I want to receive notifications by:. Exemption - Surviving Spouse Affidavit: The Nevada Legislature provides for property tax exemptions to individuals meeting certain requirements. Most affidavit of name change are used. If paternity is established after the mother leaves the hospital, the c’s last name hild may be changed when completing the Affidavit Acknowledging Paternity. Name Change Affidavit Format with PDF and Docs; Indemnity Bond Format India with PDF; Partnership Deed Format, Partnership Deed Registration with PDF; If you have any query or suggestion then do comment below. I am listed as beneficiary on policy number _____,. That I am seeking this name change on behalf of my minor child pursuant to the wishes and direction of my minor child. AFFIDAVIT REGARDING A CHANGE OF NAME WARNING False statements made knowingly and willfully on passport applications or on affidavits or other supporting documents submitted therewith are punishable by fine and/or imprisonment under the provisions of 18 U. [OR, delete whichever option is inapplicable]. Same Name Affidavit. The individual(s) making the claim will have to submit a small estate affidavit to the Probate Court located in their county or jurisdiction. If the person whose name is to be added is 1 -7 years of age, only the notarized affidavit signed by a parent must be submitted. Affidavit of Facts Relating to Title Transfer to an LLC WORD. The individual provides with this affidavit a current Certificate of Good Standing for a reinsurance intermediary. If you need extra space to complete this section, use the space provided in. While the other is as a result that you are married and hereby which to inform the public about which you should be addressed as. II - That I was born on {BIRTH DATE} in {PLACE OF BIRTH}. ) • • • XX STK# 300165 If a deceased owner's estate is not probated, their interest in a vehicle may be assigned through the use of this affidavit signed by all the heirs of the owner(s) stating the name of the person to whom the. An affidavit is a written statement that has been notarized. Here is the form of an Affidavit/Declaration in respect of 'same name' confirmation. Truth as a valid statement of reality is sovereign in commerce. does not meet the requirements of. Federal Circuit Court Rules 2001 (the Rules). The affidavit must be signed in the presence of a notary. person signing the affidavit) is the same person as the other name listed in the affidavit. Individuals who don't fully understand the implications of affidavits of occupancy may find themselves hit with financial and even criminal penalties at a later date. undersigned notary public, under oath or affirmation make the following statements: _____. No proceeding is now being or has been conducted in California for administration of the decedent's estate. Affidavit of Financial Support The Affidavit of Financial Support is required when any amount of your tuition and/or living expenses for you and any dependents are funded by a parent, spouse, relative, or other personal sponsor. This form, along with the title or transferable registration properly completed. AFFIDAVIT REGARDING A CHANGE OF NAME WARNING False statements made knowingly and willfully on passport applications or on affidavits or other supporting documents submitted therewith are punishable by fine and/or imprisonment under the provisions of 18 U. aopc 312-08 (a) commonwealth of pennsylvania plaintiff: name and address section 8 tenant’s supersedeas affidavit filed pursuant to pa. Name Change Affidavit. That by virtue of this affidavit, I changed my name from YOURNAME (old name) to CHOSENNAME (new name) and henceforth I shall be known as the CHOSENNAME (new name) for all purposes. a ffidavit or affirmation, the name of the deponent in whose support it is filed. So the first step to change your name is making an affidavit for changing your name. Consul when you apply for your student visa. The person who has the authority to notarize the Affidavit (typically a notary public) and who ensures the affiant's identity aligns with the name used in the document; Affidavits that are used in court will typically include: The name of the plaintiff or plaintiffs (the person, people, or entity who brought the dispute to court). The Declarant then has the option to just sign the Affidavit or to sign it in front of a notary public, S. License/Certificate Type. ID # Vehicle Gift Certification - Used when vehicle or trailer is given as a gift and the recipient is not a relative. Lets take an example to provide you the definition of One and Same Person Affidavit:. AFFIDAVIT OF NO OTHER SOURCES OF INSURANCE State of:_____ County of:_____ I, _____ of full age, being duly sworn according to law, on his/her oath says: 1. BEFORE ME, the undersigned authority, a duly qualified and commissioned Notary. Final determination of the name(s) to be shown in the U. undersigned notary public, under oath or affirmation make the following statements: _____. ,provide your. A surviving spouse may title the vehicle in his or her name only by submitting a title application in the spouse’s name (no fee is required if at the time of death, the deceased was a Maine resident and the vehicle was registered and titled in Maine), the vehicle’s title, and this form completed by the spouse. This affidavit has two parts: • Part One — the ID Theft Affidavit — is. Date Print Name and Company Name. the same or similar name and have never resided or conducted business at the premises indicated against the judgment debtors. pdf - AFFIDAVIT OF CURRENT INCOME Name Age SSN/ITIN I swear or affirm that I currently do not have any income of any kind I MHC_Affidavit_CurrentIncome. If you checked "I have," give the name of the court, the court case number and the date of the decision in the case or cases:. Also include the date. Verified on this day—————-at ———————that the contents of the affidavit are true and correct, nothing material has been concealed and no part of it is false. County Public Schools with the bid or offer. The advanced tools of the editor will guide you through the editable PDF template. The purpose of this Affidavit is to document benefit eligibility for your domestic partner and/or your domestic partner’s dependent(s). I got just what I needed. HUSBAND/EX-HUSBAND OF THE MOTHER:. Copy the Affidavit AFTER it has been sworn by a Commissioner for Oaths. COURT OF COMMON PLEAS. ID # Vehicle Gift Certification - Used when vehicle or trailer is given as a gift and the recipient is not a relative. Financial Affidavit – A Financial Affidavit is a type of affidavit that gives points of interest supporting or relating to a man’s budgetary status; for example, the measure of cash they have on investment funds, the measure of compensation they make every year, and also their material resources. ATTENDANT AFFIDAVIT. Important Submission Information: Submission of this form will serve as a notification of name change to all California Boards and Bureaus operating on the BreEZe system. An Affidavit Form is a written statement (confirmed by oath, declaration or affirmation) which can be used as evidence within a court. If someone made unauthorized charges to an existing account, call the company for instructions. Full Legal Name. a certified or authenticated copy of the deceased’s death certificate is attached to this affidavit; 3. The person making this affidavit We have updated the terms and conditions of our Rocket Lawyer On Call® Service Level Agreement that apply to your use of the platform and products and services provided by Rocket Lawyer. 02/10 New Mexico Taxation & Revenue Department, Motor Vehicle Division AFFIDAVIT OF ONE AND THE SAME NAME I, _____, under penalty of perjury, let it be known. STATE OF ARKANSAS ) ) SS. 902(i), Affidavit of Corroborating Witness. [Vendor’s name] 5. Consult an attorney for more information or advice. We understand that Title Company is relying on the truthfulness of the statements made in this affidavit to provide the area and boundary coverage and upon the evidence of the existing real property survey of the Property. Creating an Affidavit Document. A surviving spouse may title the vehicle in his or her name only by submitting a title application in the spouse’s name (no fee is required if at the time of death, the deceased was a Maine resident and the vehicle was registered and titled in Maine), the vehicle’s title, and this form completed by the spouse. NAME AFFIDAVIT. An Affidavit of One and the Same Person is a written document that establishes that two different names found on different documents refer to one person, the Affiant. BEFORE YOU START, READ THE INSTRUCTION GUIDE. MUST BE SIGNED IN PRESENCE OF NOTARY. Notary printed or stamped name Title and Dealer or county/office number or notary expiration date (Seal or stamp) Vehicle/ Vessel Owner Name Update Affidavit for Individual Use this form to change your name on your vehicle/vessel record or to state your name as "one and the same" as the owner of a vehicle or vessel. personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscri bed to the within instrument and acknowledge to me that he/she/they executed the same in his/her/their authorized capacity(ies), and t hat by. Affidavit must be signed by registrant if of legal age of 18 or if not of legal age by parent(s) or legal guardian in the presence of a notary public. Bidder shall complete and submit this bid/proposal affidavit to the Supervisor of Purchasing, Washington. How To Write An Affidavit. AFFIDAVIT State of _____ County of _____ I, _____, hereby request that you amend the birth record of. AFFIDAVIT OF OWNERSHIP FOR AMATEUR-BUILT AND OTHER NON-TYPE CERTIFICATED AIRCRAFT (does not include light-sport) U. NAME CHANGE AFFIDAVIT is required to complete a name change request. gov DMV-5-TR REV 11/12 West Virginia Department of Transportation Division of Motor Vehicles A˜davit of Transfer of Ownership Without Consideration. This is an affidavit form that allows a person to state under penalty of perjury or under oath that he/she is the same person as the other names listed in the affidavit. Completed affidavits will be retained and requests for copies of this affidavit should be made at the time of execution. You may use this internet module for the filing of your Fictitious Business Name Statements. County Public Schools with the bid or offer. One of the following must be provided: 1) certificate of common law marriage/informal marriage (or other comparable document) issued by a county clerk's office or other authorized issuer within the State in which the common law marriage was. Date of Statement. Affiant authorizes reports to be electronically filed with the Louisiana Board of Ethics. This form should be completed by someone other than an heir, who is familiar with the family history of the decedent, and who will obtain no benefit from the Estate. This form can be used in South Carolina. This package includes (1) Instructions and Checklist; (2) Name Affidavit under penalty of perjury; (3) Name Affidavit under oath. AFFIDAVIT OF CHANGE OF NAME NOTARY OFFICE USE ONLY SIS AAMC Registration & Student Records 550 1st Avenue, Medical Science Building, Suite G90, NY, NY 10016 Tel: (212. VERIFICATION: Despondent Verified that the contents of this affidavit are true and correct to the best of my knowledge and belief and nothing has been concealed therein. Domestic Partner’s name (please print) Employee’s name (please print) Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. ACKNOWLEDGMENT OF PATERNITY AFFIDAVIT. change of name in its records from _____ to _____. General affidavit form for use within the State of California. Affidavit - Joint Survivor WORD. Title: AFFIDAVIT/VERKLARING/STATEMENT Author: MichelleV Created Date: 5/30/2011 3:15:51 PM. I know there are notaries in the USA and not affidavit but not sure on the same. This affidavit is taken under oath and the declarant states in writing that he or she is the same person as the other name listed on the document. (Signature of Next of Kin) (Notary Public) My Commission Expires (Signature of Next of Kin) (Signature of Next of Kin) SEAL. Affidavit for Designation of Beneficiary or Beneficiaries by the Sole Owner for a Motor Vehicle, Watercraft, or Outboard Motor Certificate of Title PDF Word BMV 4175. AFFIDAVIT (LACK OF PROBATE) The undersigned affiant/grantee _____, being first duly sworn Name of Affiant deposes and states as follows: That they are a rightful heir as listed on heirs at law, to the real. I, certify that I am also known as:. AFFIDAVIT North Carolina County of _____ , appearing before the undersigned Name of principal notary and being duly sworn, says that:. Acknowledgements We understand that same sex domestic partners are subject to the same plan guidelines and eligibility provisions as all other participants of the benefit plan. personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscri bed to the within instrument and acknowledge to me that he/she/they executed the same in his/her/their authorized capacity(ies), and t hat by. gov to use a secure online version that you can print for your records. It's a legal document the provides information known personally to the person signing. suggested format: parental consent affidavit (consent for person under the age of 18 to travel to or from the republic of south name residential address. STATE OF INDIANA. State State State This affidavit is made for the purpose of securing the transfer or delivery of property owned by the decedent at the time of his or her death to a purchaser or persons legally entitled thereto under the laws of the decedent’s domicile. For example, if the affidavit says the name should be Mary Ann Doe, the proof must show the name to be Mary Ann Doe. The undersigned Grantee(s) declares as follows: 1. Same Name Affidavit. License/Certificate Type. documents must complete and sign the Erasure Affidavit. See Also - Change of Name complete process and Download Name change affidavit PDF here. application for change of name (adult) commonwealth of virginia va. Download or preview 1 pages of PDF version of Signature/name affidavit and aka statement (DOC: 101. How will you be filing? ***In-Person refers to a Registrant who is filing a Fictitious Business Name Statement (FBN) and plans to bring it into one of the RR/CC designated offices to pay, sign, and finalize the transaction. The person who fills out the firm is called the Affiant. That affiant is a resident of the. Step 4 - Affidavit of Character for Minor Child Name Change. According to 49 CFR Part 40, as amended, the collector of the drug test referenced below must take all practicable action to correct errors on the Federal Drug Testing Custody and Control Form so that the test is not cancelled. You will probably have to print your name and then provide your signature. NOTICE: You must read and initial the NOTICE OF ALTERNATIVES, RIGHTS AND RESPONSIBILITIES before you sign the affidavit. Name of Child as parents would like it to appear on birth certificate (First, Middle, Last) HUSBAND'S/EX-HUSBAND'S SIGNATURE. to file) or, per statute, be exempt. Affiant is one and the same person as: 2. Affidavit of Facts Relating to Title Transfer to an LLC WORD. Look for one on the internet. undersigned notary public, under oath or affirmation make the following statements:. Common name variations include variations with middle names, middle initials, former maiden names, suffixes to their name such as junior or senior, or 1st, or 2nd. I am executing this declaration to be submitted. AFFIDAVIT OF OWNERSHIP. Family Name (Last Name) 1. I, _____ , in the presence of the. Name of Child - First, Middle, Last (As it appears on birth certificate) Date of Birth - (Month, Day, Year) Place of Birth - City, State. 1 This affidavit must be attached to the original document when re-recording without new signatures Created 12/27/16 Indicate the minor correction identified below and set out the information corrected:. the same or similar name and have never resided or conducted business at the premises indicated against the judgment debtors. oregonlawhelp. One and the Same person Affidavit is used when the person is having different Names at various Documents and he/she want some proof in order to submit that all the Names belong to One and the Same person and reason behind different Names. Failure to timely complete and record an affidavit will result in abandonment under AS 38. 1) Name differences on Legal Documents 2) Certificate of Current Standing -Previously Registered. Affidavit for Consent for Health Care for a Minor State of West Virginia, County of _____ name of county where you are physically located at the time you sign the document After being duly sworn, I _____ provide the following information: Adult Caregiver’s Name A. Identity Theft Affidavit. application for change of name (adult) commonwealth of virginia va. documents must complete and sign the Erasure Affidavit. 6-19/4) AFFIDAVIT OF HEIRSHIP THIS AFFIDAVIT MUST BE FILED IN THE COUNTY CLERK'S RECORD. an affidavit to jesse white, the secretary of the state of illinois, pursuant to 755 ilcs 5/art. 62 KB, for Affidavit in Lieu of Certificate of Title for Salvage Vehicle (PDF 73. § 13-10-91(b) (1) By executing this affidavit, the undersigned contractor verifies its compliance with O. If you need an affidavit for a court case or other legal reasons, preparing one is easy if you know the guidelines. This form can be used to establish the parentage of a child and may be used to have information on the father of a child added to the certificate of birth for the child. Select the affidavit template. served the Affidavit (form 34) by mail, by fax, e-mail or by substituted service. Connecticut residents may apply to the Probate Court or the Superior Court for a change of name or to resolve inconsistencies in identification documents. RESPONDENT LICENSEE _____ License Address _____ _____ Printed Name. undersigned notary public, under oath or affirmation make the following statements:. Affidavit for Transfer of Title to Motor Vehicles in a Small Estate Proceeding Being first duly sworn, I state that: (1) This affidavit is made for the purpose of collecting the personal property of. Print Name Seller's BrokerjListing Agent. This affidavit is made for the purpose of securing the transfer or delivery of securities registered in the name of or owned by said decedent at the time of his/her death. Affidavit Confirming Authority Under Power of Attorney: Affidavit of Death: Affidavit of Death - Domestic Partner - Community Property with Right of Survivorship: Affidavit of Death - Joint Tenant: Affidavit of Death - Spouse - Community Property with Right of Survivorship: Affidavit of Death - Surviving Domestic Partner - Succeeding to Community Property. Priya Khosla Priya Khosla Print or Type Name Signature Priya Gupta Priya Khosla Print or Type Name Signature Priya Gupta Khosla Priya Khosla. Below you will find different affidavit templates for you to download in Adobe PDF and Microsoft Word format. without legal authority signs the name of another person (b) An offense under this section is a felony of the third degree. SIGNATURE/NAME AFFIDAVIT AND AKA STATEMENT. This affidavit cannot be used to add a parent to a birth certificate (use Acknowledgment of Parentage form DOH 422-159). That during the last ten years, I have used or have been addressed by the following names in the jurisdiction(s) and on the dates. Signature/name affidavit and aka statement in Word and Pdf formats Toggle navigation. It is for general purposes rather than designed specifically for a certain situation, such as a statement of name change. Transfer by Affidavit Form Until recently, the Wisconsin Court System’s Records Management Committee (RMC) has maintained a transfer by affidavit form, which is used to transfer property of decedents with estates of $50,000 or less. put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. form cc-1411 (master, page one of two) 07/18. The second form is a "Name Affidavit under oath" where the notary states that he/she gave the Declarant (the person making the declaration) an oath and that under oath, the Declarant stated that he/she is the same person as the other name listed on the affidavit. IMPORTANT: This form cannot be submitted electronically. partner or by a change of my circumstance attested to in this affidavit. I request LIC Mutual Fund to take note of above and make necessary changes in its record. Posted by CourthouseDirect. pdf - AFFIDAVIT OF CURRENT. If you checked "I have," give the name of the court, the court case number and the date of the decision in the case or cases:. CHILD’S NAME. Fill out an affidavit of one and the same name for a person you know intimately, such as a spouse or relative. AFFIDAVIT is a written statement made under oath. The purpose to create this Affidavit is to give declaration about the incorrect name and to get it correct while submitting the Affidavit to the concern authorities. Below you will find a list of Affidavits which you can download in word or pdf and customize them as per your requirements. Date: / / AFFIDAVIT OF FACT (PWD 314) Check whether this applies to a boat, outboard motor or both and fill in all the blocks for each one checked. The undersigned further declared that they are: (check one). Affidavit - Facts Relating to Title to Real Estate PDF. THIS day of , 20. ) (Print or Type Name) Signature. AFFIDAVIT OF IDENTITY - FICTITIOUS BUSINESS NAME STATEMENT If submitting the Fictitious Business Name Statement by MAIL or through a THIRD PARTY, the registered owner MUST bring this page to a notary to be NOTARIZED. General Affidavit Form. Form I-864 03/06/18. Download or preview 1 pages of PDF version of Signature/name affidavit and aka statement (DOC: 101. Identity Theft Victim's Complaint and Affidavit A voluntary form for filing a report with law enforcement, and disputes with credit reporting agencies and creditors about identity theft-related problems. , or I/II/III/IV to your name ADDING A CO-OWNER TO A CURRENT ACCOUNT:. AFFIDAVIT OF DONOR (PRIOR OWNER) Under penalty of perjury, the undersigned donor (prior owner) affirms that the vehicle or boat identified above was transferred by him or her as a gift to the recipient (new owner) on the date indicated and that no payment was received in consideration of the transfer of ownership. This Name Affidavit must be signed in the presence of a notary, solicitor or commissioner of oaths. The person who fills out the firm is called the Affiant. Title: AFFIDAVIT/VERKLARING/STATEMENT Author: MichelleV Created Date: 5/30/2011 3:15:51 PM. CONTRACTOR’S FINAL AFFIDAVIT STATE OF FLORIDA COUNTY OF _____ BEFORE ME, the undersigned authority, personally appeared, (contractors personal name) who after being duly sworn, deposes and says: 1.