HomeMy WebLinkAboutAFFIDAVIT FOR SID- INCOMPETENTI_1aJ417_1Tj111111
STATE OF HAWAII )
being first duly sworn,
deposes 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) 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:
PRINTED NAME
IDENTIFICATION PRESENTED EXR DATE
SIGNATURE OF EXAXIINER DATE
FOR NOTARY USE ONLY:
Subscribed and sworn before my this day
of 120
Notary Public
State of
My commission expires:
Judicial Circuit
NOTARY CERTIFICATION
(Hawaii Administrative Rules 5 -11 -8)
Document Date: No. Pages:
Document
Description:
Notary Printed Name Circuit
Notary Signature Date
(Stamp or Seal)
(Stamp or Seal)