AFFIDAVIT
HIGHLY CONFIDENTIAL – FOR INFORMATION AND PUBLIC ARCHIVE REGISTRATION ONLYSTATE OF [State/Province]
COUNTY OF [County]I, [Full Name], being of sound mind and lawful age, residing at [Full Address], do solemnly swear or affirm under penalty of perjury that the following statements are true and correct to the best of my knowledge:
[Full Name of Affiant]
NOTARY ACKNOWLEDGMENTSTATE OF [State/Province]
COUNTY OF [County]On this [Day] day of [Month], [Year], before me, a Notary Public in and for said County and State, personally appeared [Full Name of Affiant], known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that they executed the same for the purposes therein contained.IN WITNESS WHEREOF, I have hereunto set my hand and official seal.Notary Public: _____________________________
Name: [Notary’s Full Name]
Commission Number: [Notary’s Commission Number]
Commission Expires: [Expiration Date][Notary Seal]
Important Notes:
COUNTY OF [County]I, [Full Name], being of sound mind and lawful age, residing at [Full Address], do solemnly swear or affirm under penalty of perjury that the following statements are true and correct to the best of my knowledge:
- Purpose of Affidavit: This affidavit is executed for the sole purpose of providing information to [Specify Third Party or Entity, e.g., "relevant third parties"] and for registration in the public archive as a record of [state purpose, e.g., "my declaration of certain facts"]. This document is highly confidential and not intended for unauthorized disclosure or use beyond its stated purpose.
- Statement of Facts:
a. [Describe the first fact or statement clearly and concisely, e.g., "I am the lawful owner of the property located at [Property Address]."]
b. [Include additional relevant facts, e.g., "On [Date], I entered into an agreement with [Party Name] for [Purpose of Agreement]."]
c. [Provide any other pertinent details, ensuring clarity and specificity.] - Confidentiality Notice: This affidavit contains sensitive and confidential information. It is provided solely for the purpose of [state purpose, e.g., "notification and archival registration"] and shall not be disclosed, reproduced, or used for any other purpose without my express written consent, except as required by law.
- Registration in Public Archive: I hereby authorize the registration of this affidavit in the [Specify Public Archive, e.g., "County Recorder’s Office" or other relevant public registry] for the purpose of establishing a public record. This registration does not waive the confidential nature of the information contained herein.
- No Waiver of Rights: The submission of this affidavit to [Third Party or Entity] or its registration in the public archive does not constitute a waiver of any rights, privileges, or protections afforded to me under applicable law.
- Certification: I certify that the foregoing statements are true and accurate to the best of my knowledge and belief. I understand that providing false information in this affidavit may subject me to penalties under the law.
[Full Name of Affiant]
NOTARY ACKNOWLEDGMENTSTATE OF [State/Province]
COUNTY OF [County]On this [Day] day of [Month], [Year], before me, a Notary Public in and for said County and State, personally appeared [Full Name of Affiant], known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that they executed the same for the purposes therein contained.IN WITNESS WHEREOF, I have hereunto set my hand and official seal.Notary Public: _____________________________
Name: [Notary’s Full Name]
Commission Number: [Notary’s Commission Number]
Commission Expires: [Expiration Date][Notary Seal]
Important Notes:
- Customization: This is a generic template. Modify it to include specific details relevant to your situation, such as the nature of the third party, the specific facts being sworn to, or the public archive where it will be registered.
- Confidentiality: If the affidavit is highly confidential, ensure that any third party receiving it is aware of its restricted use. You may need to include a confidentiality agreement or clause depending on the context.
- Legal Compliance: The format and requirements for affidavits vary by jurisdiction. Verify the notarization and filing requirements for the relevant state, county, or country.
- Public Archive: Confirm the specific public archive (e.g., county recorder, state registry) and its procedures for filing. Some jurisdictions may have specific forms or fees for registration.
- Consult an Attorney: Given the confidential and legal nature of this document, consult a licensed attorney to ensure it meets your needs and complies with local laws.