Affidavit of Address Change

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									Affidavit of Address Change
An Affidavit of Address Change may be necessary to inform creditors, the city, the
government, clients, or consumers of an individual or company’s official address
change. Customize the name of the person that will sign this affidavit, the old address,
the new address, and the effective date of the address change. This affidavit should be
used by individuals or small businesses that want to certify under the penalty of perjury
that they have changed addresses.
                              AFFIDAVIT OF ADDRESS CHANGE

STATE OF _________________ [Instructions: Insert the state where this affidavit will be
signed]

COUNTY OF _________________ [Instructions: Insert the county where this affidavit will
be signed]



_______________________, [Instructions: Insert the name of the individual executing this
affidavit, hereinafter referred to as the “Affiant”] being duly sworn according to law, deposes
and attests under penalty of perjury to the following:

I, _________________________, [Instructions: Insert the Affiant’s name] of
_____________________________________________ [Instructions: Insert the Affiant’s new
address] being first duly sworn on oath, state that:

    1. I am over 18 years of age and competent enough to testify of my own knowledge of the
       facts stated herein.

    2. All the facts stated by me herein are true, correct and complete to the best of my
       knowledge and understanding.

    3. As of ___________________, [Instructions: Insert the effective date of the address
       change] my old address of _____________________________________________,
       [Instructions: Insert the Affiant’s old address] should no longer my address of record.

    4. My new address of record where all future correspondences, official mailings, letters and
       inquiries should be sent is _____________________________________________.
       [Instructions: Insert the Affiant’s new address]

I swear that to the best of my knowledge, the information contained in this affidavit is true and
correct as of _________________. [Instructions: Insert the date that Affiant will sign this
affidavit]

Printed Name of Affiant: _________________ [Instructions: Insert the Affiant’s name]

Signature of Affiant: _________________________________________ [Instructions: Insert
the Affiant’s signature]
Signed on _________________ [Instructions: Insert the date that Affiant will sign this
affidavit]

Address of Affiant: _____________________________________________ [Instructions:
Insert the Affiant’s new address]


© Copyright 2013 Docstoc Inc. registered document proprietary, copy not              2
Notary Form

STATE OF                                       }
COUNTY OF                                      }

On ________________________________ before me, __________________________,
personally appeared ___________________________________________________, personally
known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose
name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they
executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s)
on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed
the instrument.

WITNESS my hand and official seal.


_____________________________
Signature


Affiant: _____Known _____Unknown

ID Produced: __________________________


[Seal]




© Copyright 2013 Docstoc Inc. registered document proprietary, copy not                 3

								
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