HomeMy WebLinkAboutAFFADAVIT FOR SID- MINOR (2)I_1aJ417_1Tj111111111
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 is at least 10 years of age and under the age of fourteen (14) and 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/AIOTHER/GUARDIAN
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:
(Stamp or Seal)
FORM: VRL -L (SID) 401
REV. 01/03/2013
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)