Free 46538.pdf - Indiana

PARENT / GUARDIAN AFFIDAVIT
State Form 46538 (R / 2-96)

PARENT / GUARDIAN AFFIDAVIT
State Form 46538 (R / 2-96)

State of Indiana County of ______________________________

State of Indiana County of ______________________________

______________________________________________________________
Name of parent/legal guardian

______________________________________________________________
Name of parent/legal guardian

Deposes and says upon his/her oath that: ______________________________________________________________
Name of applicant

Deposes and says upon his/her oath that: ______________________________________________________________
Name of applicant

is my natural or legal child and that the signature below is his/her true and valid signature.
Signature of applicant

is my natural or legal child and that the signature below is his/her true and valid signature.
Signature of applicant

Applicant's Driver License /SS number (voluntary)

Applicant's date of birth (month, day, year)

Applicant's Driver License /SS number (voluntary)

Applicant's date of birth (month, day, year)

I swear or affirm that the information I have entered on this form is correct. I understand that making a false statement on this form may constitute the crime of perjury.
Signature of parent/ legal guardian

I swear or affirm that the information I have entered on this form is correct. I understand that making a false statement on this form may constitute the crime of perjury.
Signature of parent/ legal guardian

Date signed (month, day, year)

Parent/legal guardian Driver's license number/ State I.D. number

Date signed (month, day, year)

Parent/legal guardian Driver's license number/ State I.D. number