Notarized Proof of Address

Date_____________________________

I ____________________________________________, certify the following person(s):

______________________________________________________________

______________________________________________________________

______________________________________________________________

____________________________________________________________ live(s) with

me at the following address:

______________________________________________________________

______________________________________________________________

If you have any questions please call me at ___________________________

______________________________ __________________________
Owner or Lessee Signature Parent/Guardian Signature

Sworn to and subscribed before me.

This is ________ day of _____________,20____.

_________________________________________
Notary Public

My commission expires: _____________________