IN THE COUNTY COURT, IN AND FOR MARION COUNTY, FLORIDA STATE OF FLORIDA vs. _________________________________________ Defendant CASE NUMBER _____________________ FALSE IDENTIFICATION AFFIDAVIT Before me, the undersigned authority, personally appeared the Defendant, who having been first duly sworn, deposes and says: 1. My full legal name is _____________________________________________; my permanent address is _____________________________________________________; and I am charged with having committed the following offense(s) on the ________ day of ____________________,_______, in Marion County, Florida: _________________________________________________________________________________ _________________________________________________________________________________ 2. I am denying the commission of said infractions for the following reason(s): (Explain your defense in your own words and do not omit any material facts that will help the judge arrive at a judgment in your case.) PRINT OR TYPE (IF MORE SPACE IS NEEDED FOR EXPLANATION - USE REVERSE SIDE) 3. I have reason to believe the person who used my name at the time of the violation is ____________________________________________, date of birth __________________, and who resides at __________________________________________________________________. 4. I hereby request this Honorable Court dismiss the charge(s) filed against me and set aside any driver's license Form TM0194v Page 1.2 suspension orders heretofore issued for said charge(s). False Identification Affidavit Page Two 5. Under penalty of perjury and possible contempt of court proceedings, I hereby swear or affirm that the foregoing statements are true and correct to the best of my knowledge. __________________________________________ Signature of Affiant/Defendant __________________________________________ Mailing Address __________________________________________ City, State, Zip Code __________________________________________ Telephone Number(s) SWORN TO AND SUBSCRIBED BEFORE ME, on ________________________, 20______. DAVID R. ELLSPERMANN Clerk of the Circuit Court Marion County, Florida _________________________________________ Notary Public, State of Florida At Large OR By________________________ Deputy Clerk GAffiant is personally known to me. GAffiant produced identification, to wit: NOTE: If you are charged with having committed a civil infraction, your case will be scheduled for a hearing on the next available docket. You will be notified by mail of the date and time to appear and your appearance is mandatory unless excused by the Court. You should bring any documents or other exhibits with you that may assist in your defense. Form TM0194v Page 2.2