HomeMy WebLinkAboutSID Minor AffidavitFORM: VRL-L (SID) 401
REV. 03/06/2023
AFFIDAVIT FOR MINOR – STATE IDENTIFICATION CARD
)
STATE OF HAWAII )
)
being first duly sworn,
deposes and says: I am the [ father mother guardian] of
born on
(FULL LEGAL NAME OF CHILD) (DATE OF BIRTH OF CHILD)
That this affidavit has been made in connection with the desire of Affiant to secure a state civil identification
card on behalf of the minor child;
That the minor child requires Affiant’s signature;
That Affiant is submitting two (2) documents in support of proof of principal residence address as indicated
under the List of Acceptable Documents for Proof of Principal Residence Address displaying name and address
of Affiant and;
Further Affiant sayeth naught.
Dated:
___________________________________________
SIGNATURE OF FATHER/MOTHER/GUARDIAN/AUTHORIZED DHS DESIGNEE
PRINTED NAME
IDENTIFICATION PRESENTED EXP. DATE
________________________________________
SIGNATURE OF EXAMINER DATE
FOR NOTARY USE ONLY:
Subscribed and sworn before my this __________ day NOTARY CERTIFICATION
(Hawaii Administrative Rules 5-11-8)
of __________________________ , 20___________ .
Document Date:_____________No. Pages:________
____________________________________________
Notary Public
Document
Description:_________________________________
State of ___________________, _______Judicial Circuit ________________________ _________________
Notary Printed Name Circuit
My commission expires: ___________________________ ________________________ _________________
Notary Signature Date
(Stamp or Seal)
(Stamp or Seal)