Illinois Affidavit of Residency Template
This Illinois Affidavit of Residency is a sworn statement made under the provisions of the laws of the State of Illinois relating to the establishment of residency within the state. It serves to confirm the residency status of an individual for a variety of legal needs, including, but not limited to, personal identification, voter registration, and eligibility for various state benefits.
To complete this affidavit, please provide accurate and truthful information in the designated sections below. This document, once filled out, must be signed in the presence of a notary public or another individual legally authorized to administer oaths in the State of Illinois.
Affidant Information
Full Name: ____________________________________________
Current Address (Street, City, State, Zip Code): _________________________________
Date of Birth: ___________________________________________
Illinois Driver’s License or State ID Number: _________________________________
Statement of Residency
I, the undersigned, swear or affirm under penalty of perjury under the laws of the State of Illinois that the information provided above is true and accurate to the best of my knowledge and that I am a legal resident of the State of Illinois. My residence, as provided in this affidavit, constitutes my main place of domicile and is the location where I intend to maintain my permanent presence.
Additional Information
Any additional information which supports the claim of residency in Illinois may be provided below. This can include, but is not limited to, utility bills, lease agreements, or other documents indicating the affiant's address and stay in the state.
______________________________________________________________________________________
______________________________________________________________________________________
Sworn and Affirmed
I hereby declare, under penalty of perjury, that the above statements are true and correct to the best of my knowledge and belief. I understand that this affidavit is made for the purpose of establishing my residency in the State of Illinois and may be subject to verification.
Date: ________________________
Signature of Affiant: ____________________________________
Subscribed and sworn to (or affirmed) before me on the ______ day of _______________, 20____, by _____________________________________ [name of affiant], proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me.
Notary Public/Authorized Official Signature: _________________________________
Printed Name: ___________________________________________
Commission Expires: _____________________________________