PASSPORT AFFIDAVIT (United States Only) State of Georgia County of _____________________ Before me this ______day of____________, ______(year), personally appeared _________________________ (Name of Affiant/Passport Bearer) who under oath or affirmation makes following statements: I am the legal bearer United States Passport No._________________, issued on __________________ and (Date of Issuance) expiring on _____________________. My date of birth is ___________________. I hereby authorize a notary (Date of expiration) public to issue a certified copy of my passport from the original. __________________________________________________ (Signature of Affiant/Passport Bearer) Sworn to (or affirmed) and subscribed before me this ______________day of ______________, _______(year), by _____________________________________. (Name of Affiant/Passport Bearer) ____Personally Known ____Produced Identification Type and # of ID______________________ ________________________________________________________ Signature of Notary Notary Seal ________________________________________________________ Name of Notary, Typed, Stamped, or Printed CERTIFICATE OF CERTIFIED COPY State of Georgia County of _____________________ On this ________day of____________, ______(year) I certify that the preceding or attached document is a true, exact, complete, and unaltered photocopy made by me of an original United States Passport in the name of __________________________________, Passport No _________________ issued on _____________________and expiring on __________________, presented to me by (Date of Issuance) (Date of Expiration) the document’s custodian ____________________________and that, to the best of my knowledge, (Name of Custodian) this passport is neither a public record nor a publicly recordable document, certified copies of which are available from an official source other than a notary public. ________________________________________________________ Notary Seal Signature of Notary ________________________________________________________ Name of Notary, Typed, Stamped, or Printed Georgia Superior Court Clerks’ Cooperative Authority American LegalNet, Inc. www.FormsWorkflow.com