US Passport Affidavit Ver E
United States of America Passport Affidavit
I, __________________________________________________ , personally appeared before the
Name of Affiant
undersigned notary public, and under oath or affirmation make the following statements:
I am in possession of United States Passport No. ____________________________________ ,
that bears the name ___________________________________________________________
Name on Passport
issued on ___________________________ and expiring on __________________________
I, hereby declare that the reproduction of this passport is a true, correct and complete photocopy
of the passport in my possession or control.
______________________________________ Date: ______________________
(Signature of Affiant)
State of Georgia
County of _________________
Signed and sworn to (or affirmed) before me on ____________________
by ________________________________________________________,
Printed name of Affiant/Passport Bearer
who proved to me on the basis of satisfactory evidence to be the person
who appeared before me.
____ Personally Known
____ Produced Identification
Type of ID ____________________________________
Signature of notary public
(Name of notary, typed, stamped or printed)
Notary Public State of Georgia Stamp/Seal
My commission expires: ___________