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Sword Affidavit of Identity and Residency

As applicable, sign and date in a presence of a law enforcement officer, a notary, or a witness.

I, the Affiant herein, being first duly sworn upon oath do hereby state that:
  • 8. I understand that if I willfully make false statements on the Affidavit, I may be punished by fine or imprisonment.

I certify that, to the best of my knowledge and belief, all of the information on and attached to this complaint is true, correct, and complete and made in good faith. I understand that this complaint or the information it contains may be made available to federal, state, and/or local law enforcement agencies for such action within their jurisdiction as they deem appropriate. I understand that knowingly making any false or fraudulent statement or representation to the government may violate federal, state, or local criminal statutes, and may result in a fine, imprisonment, or both.

If you do not choose to file a report with law enforcement, you may use this form as an Identity Theft Affidavit to prove to each of the companies where the thief misused your information that you are not responsible for the fraud. While many companies accept this affidavit, others require that you submit different forms. Check with each company to see if it accepts this form. You should also check to see if it requires notarization. If so, sign in the presence of a notary. If it does not, please have one witness (non-relative) sign that you completed and signed this Affidavit.









  • Sworn to and subscribed before me thisday of ,20,
  • by , who was personally known to me or who presented
  • as identification.



  • Signature of Notary

          or Witness

  • Signature

  • Date

  • Printed Name

  • Telephone Number
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