Form 2306606 - Affidavit Of Shared Residence - State Of Arizona
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1State of Arizona
Affidavit of Shared Residence
I swear or affirm that I am a resident of the State of Arizona and that the persons listed below reside with
me at my residence, described as follows:
Persons who reside with me:
_____________________________________________________________________________
______________________________________________________________________________
Location of my residence:
____________________________________________________________________________________
I submit in support of this attestation a copy of the following document that displays my name and current
residence address or physical description of my property:
___
Valid Arizona driver’s license, Arizona identification card or motor vehicle registration
___
Valid U.S. passport
___
Real estate deed or mortgage documents
___
Property tax bill
___
Residential lease or rental agreement
___
Water, electric, gas, cable, or phone bill
___
Bank or credit card statement
___
W-2 wage statement
___
Payroll stub
___
Certificate of tribal enrollment or other identification issued by a recognized Indian tribe.
___
Documentation from a state, tribal or federal government agency (Social Security Administration,
Veteran’s Administration, Arizona Department of Economic Security)
Printed Name of Affiant:
______________________________
Signature of Affiant:
______________________________
Acknowledgement
State of Arizona
County of __________________________
The foregoing was acknowledged before me this ____ day of _______________, 20____,
By ____________________________________.
_______________________________
Notary Public
My Commission Expires:
_____________________
#2306606
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