HomeMy WebLinkAboutAFFIDAVIT FOR SID- INCOMPETENTAFFIDAVIT ) STATE OF HAWAII ) ) being first duly sworn, d eposes and says: I am the [ guardian custodian have control/maintenance ] of SSN (FULL LEGAL NAME OF INCOMPETENT INDIVIDUAL ) That this affidavit has been made in connection with the desire of Affiant to secure a state civil identification card on behalf of the incompetent individual ; That Affiant is submitting two (2) docume nts 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 GUARDIAN /CUSTODIAN/HAVE CONTROL/MAINTENANCE 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)