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    Affidavit of Identifying Witness

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    kris
    This document is an affidavit form that must be completed by an identifying witness for a passport applicant who is unable to establish their own identity. The form collects information about the witness such as their name, address, and basis of knowledge of the applicant. It also collects identification information for both the applicant and witness. The witness must declare under penalty of perjury that the information provided is true and the form must be signed in the presence of an authorized agent.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Affidavit of Identifying Witness

    Uploaded by

    kris
    32 views2 pages
    This document is an affidavit form that must be completed by an identifying witness for a passport applicant who is unable to establish their own identity. The form collects information about the witness such as their name, address, and basis of knowledge of the applicant. It also collects identification information for both the applicant and witness. The witness must declare under penalty of perjury that the information provided is true and the form must be signed in the presence of an authorized agent.

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    This document is an affidavit form that must be completed by an identifying witness for a passport applicant who is unable to establish their own identity. The form collects information about the witness such as their name, address, and basis of knowledge of the applicant. It also collects identification information for both the applicant and witness. The witness must declare under penalty of perjury that the information provided is true and the form must be signed in the presence of an authorized agent.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    32 views2 pages

    Affidavit of Identifying Witness

    Uploaded by

    kris
    This document is an affidavit form that must be completed by an identifying witness for a passport applicant who is unable to establish their own identity. The form collects information about the witness such as their name, address, and basis of knowledge of the applicant. It also collects identification information for both the applicant and witness. The witness must declare under penalty of perjury that the information provided is true and the form must be signed in the presence of an authorized agent.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    OMB APPROVAL NO.

    1405-0088
    U.S. Department of State EXPIRATION DATE: 03/31/2009
    ESTIMATED BURDEN: 5 MINUTES*
    AFFIDAVIT OF IDENTIFYING WITNESS
    (IDENTIFICATION OF A PASSPORT APPLICANT)
    This form should be completed ONLY by the identifying witness.
    1. Passport Applicant's Name (Last, First, Middle)

    2. Basis of your knowledge concerning the Passport Applicant (Such as your relationship to the applicant)

    3. How long have you (The Witness) known the Passport Applicant?
    Years Months

    WITNESS INFORMATION
    4. Witness' Name (Last, First, Middle)

    5. Witness' Residential Address

    City, State, ZIP Code

    6. Witness' Place of Birth (City, State, Zip Code) 7. Witness Date of Birth (mm-dd-yyyy)

    8. Witness Daytime Telephone Number 9. Witness Home Telephone Number 10. Have you as the witness been issued a U.S.
    Passport? Yes No
    ( ) ( ) If yes, continue with questions #11 - 13.
    11. Witness Passport Number 12. Place of Issue if Possible 13. Date of Issue (mm-dd-yyyy)
    If necessary, give approximate.

    NOTE Read the Following Oath but DO NOT SIGN the Affidavit Until Requested to do so by an Authorized
    Acceptance Agent.
    I declare under penalty of perjury that I know or have reason to believe the above-named passport applicant is a citizen
    or non-citizen national of the United States; and the above statements are true and correct.

    Signature Date (mm-dd-yyyy)

    FOR ACCEPTANCE AGENT'S USE ONLY


    Subscribed and sworn to (affirmed) before me (Seal) Clerk of Court
    Passport Agent Location
    Signature
    Postal Employee
    (Vice) Consul USA Date (mm-dd-yyyy)
    APPLICANT'S IDENTIFICATION
    1. Issued in the Name of Type of Document Document Number

    Place of Issue Date of Issue (mm-dd-yyyy) Date of Expiration (mm-dd-yyyy)

    2. Issued in the Name of Type of Document Document Number

    Place of Issue Date of Issue (mm-dd-yyyy) Date of Expiration (mm-dd-yyyy)

    WITNESS' IDENTIFICATION
    Issued in the Name of Type of Document Document Number

    Place of Issue Date of Issue (mm-dd-yyyy) Date of Expiration (mm-dd-yyyy)

    DS-71
    03-2006 Page 1 of 2
    This affidavit is required to be included with a passport application only when the applicant for a passport is unable to
    establish his or her identity to the satisfaction of a person authorized to accept passport applications. The applicant
    must still present some identification of his or her own. Witnesses must complete items one through ten (and if
    applicable, eleven through thirteen), sign when requested to do so by the same authorized acceptance agent who
    accepted the passport application, and present some form of current photo identification of his or her own.

    PLEASE PRINT LEGIBLY IN BLUE OR BLACK INK ONLY.

    PRIVACY ACT AND PAPERWORK REDUCTION ACT STATEMENTS

    AUTHORITIES The information solicited on this form may be requested pursuant to provisions in Titles 8 and
    22 of the United States Code (U.S.C.), whether or not codified including specifically 22 U.S.C. 211A and all
    regulations issued pursuant to Executive Order 11295 (August 5, 1966), including Part 51, Title 22, Code of
    Federal Regulations (CFR).

    PURPOSE The primary purpose for soliciting the information is to establish citizenship, identity, and entitlement
    to issuance of a U.S. passport. The information may also be used in connection with issuing other travel
    documents or evidence of citizenship, and in furtherance of the Secretary's responsibility for the protection of U.S.
    nationals abroad.
    ROUTINE USES The information solicited on this form may be made available as a routine use to other
    government agencies, to assist the U.S. Department of State in adjudicating passport applications and requests for
    related services, and for law enforcement and administrative purposes. It may also be disclosed pursuant to court
    order. The information may be made available to foreign government agencies to fulfill passport control and
    immigration duties or to investigate or prosecute violations of law. The information may also be made available to
    private U.S. citizen 'wardens' designated by U.S. embassies and consulates.

    Failure to provide the information requested on this form may result in the denial of a United States passport,
    related documents, or service to the individual seeking such passport, documents, or service.

    *Public reporting burden for this collection of information is estimated to average 5 minutes per response, including
    time required for searching existing data sources, gathering the necessary data, providing the information required,
    and reviewing the final collection. You do not have to provide the information unless this collection displays a
    currently valid OMB number. Send comments on the accuracy of this estimate of the burden and
    recommendations for reducing it to: U.S. Department of State (A/ISS/DIR) Washington, DC 20520.

    WARNING
    False statements made knowingly and willfully in passport applications or in affidavits or other supporting
    documents submitted therewith are punishable by fine and/or imprisonment under provisions of 18 U.S.C. 1001
    and/or 18 U.S.C. 1542. Alteration or mutilation of a U.S. passport is punishable by fine and/or imprisonment under
    provisions of 18 U.S.C. 1543. The use of a U.S. passport in violation of the restrictions contained therein or of the
    passport regulations is punishable by fine and/or imprisonment under 18 U.S.C. 1544. All statements and
    documents submitted are subject to verification.

    DS-71 Page 2 of 2

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