(Rev 06/22/2020)
Instructions
The applicant may use this affidavit along with the two (2) proof of residential address documents provided by the individual whose
name is on the documents to meet the residential address requirements in Florida. The Certification of Address document must be
complete, legible, and signed by the applicant and the individual who is certifying the customer resides at their address.
1. Customers that cannot provide two (2) documents that show their name and current residential address may provide documents in
the name of the person they reside with along with document(s) demonstrating family relationship.
Acceptable documents demonstrating family relationship may include, but are not limited to:
• Marriage certificate
• Military dependent identification card
• Birth certificate
• Adoption record
Customers who are unable to provide documents to establish the relationship, may provide the two (2) documents and a completed
Certification of Address document from the person whose name is on the residential address document. The individual whose name
is on the documents and Certification of Address may appear in person and sign the document in the presence of the issuance
personnel or they may sign the document in the presence of a notary.
Minors: May provide two (2) documents that show their residential address in the name of the parent/guardian who is signing the
parental consent form or the process outlined above.
2. Customers who are homeless and reside in an agency where housing services are provided (homeless shelter, probation home,
etc) may provide a letter from the housing agency with the residential address and statement that the customer resides at the
location and a Certification of Address document with Section A completed self-certifying their residential address.
Customers who are homeless and do not reside in an agency where housing services are provided (homeless shelter, probation
home, etc.), may provide a Certification of Address document with Section A completed self-certifying their residential address
as General Delivery.
Acceptable Residential Address Documents:
1. Deed, mortgage, monthly mortgage statement, mortgage payment booklet or residential rental/lease agreement.
2. Florida Voter Registration Card.
3. Florida Vehicle Registration or Title.
4. Florida Boat Registration or Title.
5. Certification of Address
6. A utility bill or hook up/work order.
7. Automobile Payment Booklet.
8. Selective Service card.
9. Medical or health card.
10. Medical bill.
11. Homeowner’s insurance policy or bill.
12. Automobile insurance policy or bill.
13. Educational institution transcript forms.
14. Professional license issued by a government agency in the U.S.
15. W-2 form or 1099 form.
16. Form DS2019, Certificate of Eligibility for Exchange Visitor (J-1) status.
17. A letter from a homeless shelter, transitional service provider, or half-way house verifying that the customer resides at the shelter
address.
18. Mail from financial institutions; including checking, savings, credit card statements or investment account statements.
19. Mail from Federal, State, County or City government agencies (including city and county agencies).
20. Personal mail that does not list the recipient as “occupant”. Example: Magazines, journals, etc.
21. Florida Department of Law Enforcement (FDLE) Registration form completed by the local sheriff’s department or Department of
Corrections.
