AFFIDAVIT OF IDENTITY
The Affidavit of Identity is used to authenticate your identity and verify your signature. This form
will need to be notarized.
STATE OF New Jersey
COUNTY OF ___________________________
I, the affiant herein, being first duly sworn upon oath does hereby state:
1. That my legal name is _______________________________________________________________
2. That my U.S. Government number (SSN or ITIN) is _______________________________________
3. That my current Physical Address is (will not accept a PO Box) _____________________________
_________________________________________________________________________________
4. That my date of birth is ______________________________________________________________
5. That I did present to my Notary Public, as proof of my identity, a valid state/U.S. government issued
Photo ID.
Type: Driver’s License Identification Card or Other (please describe) ______________
Issued in the State of: __________________________
(required if Driver’s License or ID Card selected)
Number: _________________________________
6. That the purpose of this Affidavit is to establish and verify that the Affiant is the same as the individual
who is named on the attached New Jersey Income Tax Return.
7. That the Affiant understands that falsification in any degree of this Affidavit is a criminal
offense and will subject such Affiant to prosecution to the fullest extent of the law.
Signature of Affiant ____________________________________________________________________
Print full legal name of Affiant ____________________________________________________________
Current Telephone Number of Affiant ______________________________________________________
Notary Public:
* Subscribed and sworn to (or affirmed) before me on this _____ day of _______________, 20____, by
_______________________________ (Affiant), proved to me on the basis of presentation of satisfactory
evidence to be the person(s) who appeared before me.
Signature________________________________________
Notary Public
Seal:
