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 ____________________ Date 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 or ____ Produced Identification Type of ID ____________________________________ _______________________________ Signature of notary public _______________________________ (Name of notary, typed, stamped or printed) Notary Public State of Georgia My commission expires: ___________ Stamp/Seal US Passport Affidavit Ver E American LegalNet, Inc. www.FormsWorkFlow.com