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AFFIDAVIT OF RESIDENCE <br />Name <br />Street Address <br />City, State <br />Zip <br />Date <br />To Whom This May Concern, <br />I, formally acknowledge living at the street address of <br />City of State of <br />20 <br />since <br />I have attached the following documents for your consideration showing no less than 30 days of <br />residency address from date of signing this affidavit: <br />Li Proof of Home Ownership/Rental Property <br />LL Proof of Motor Vehicle Registration <br />u Utility Bill — electric, water, sewer, refuse, internet, cable TV or landline phone services <br />u Other: <br />Furthermore, I swear and affirm under penalty of perjury that the facts set forth in this statement <br />are true and accurate. Executed this _ day of 20_, in <br />California. <br />Declarant's signature <br />Declarant's name (printed) <br />55B-13 <br />