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DEPARTMENT OF SOCIAL SERVICES (Model Form) Page 1 of 7 SWORN STATEMENT OR AFFIRMATION FOR CHILD DAY PROGRAMS Please Print Last Name Current Mailing Address Name of Licensed/Registered Approved Facility/Provider

How to fill out sworn statement or affirmation

To fill out a sworn statement or affirmation, follow these points:

1. Begin by including the heading. Write "Sworn Statement" or "Affirmation" at the top of the document, clearly indicating the purpose of the statement.
2. Provide your personal information. Include your full name, address, and contact information on the document. This information will help identify you as the declarant.
3. State the purpose of the statement. Clearly explain the reason for the sworn statement or affirmation. This could be related to a legal matter, an insurance claim, employment verification, or any other situation requiring a formal statement.
4. Compose the body of the statement. Use clear and concise language to explain the facts or details relevant to the purpose of the document. Be honest and provide accurate information.
5. Include a verification clause. This is a crucial component of a sworn statement or affirmation. It typically states that you understand the consequences of making false statements and that you affirm the truthfulness of the information provided.
6. Sign the statement. At the end of the document, include a signature line for you to sign and date the statement. This signature serves as an indication that the information contained in the statement is true and correct to the best of your knowledge.
7. Notarize the statement if necessary. Depending on the jurisdiction and the intended use of the sworn statement or affirmation, you may need to have it notarized. This involves presenting the document to a notary public who will witness your signature and officially authenticate the document.

Who Needs Sworn Statement or Affirmation:

1. Legal proceedings: In various legal situations such as court proceedings, affidavits, or depositions, sworn statements or affirmations may be required. Parties involved in litigation or serving as witnesses often need to provide sworn statements to preserve the truth under oath.
2. Government agencies: When dealing with government agencies, individuals may need to provide sworn statements or affirmations for matters such as license applications, permits, benefits claims, or declaring eligibility for certain programs.
3. Employment or licensing requirements: Some professions, such as law enforcement officers, healthcare professionals, or educators, may require individuals to provide sworn statements or affirmations as part of the hiring, licensing, or certification process.
4. Insurance claims: When filing an insurance claim, individuals may need to provide a sworn statement or affirmation to verify the details of the incident or to confirm the accuracy of the claimed losses.
5. Financial transactions: In certain financial or business transactions, parties involved may require sworn statements or affirmations to confirm the accuracy of financial information, investment disclosures, or loan applications.

Remember, the requirements for sworn statements or affirmations may vary depending on the jurisdiction and the specific purpose. It is essential to consult with legal professionals or refer to specific guidelines to ensure compliance with applicable laws and regulations.

For pdfFiller’s FAQs

What is sworn statement or affirmation?

A sworn statement or affirmation is a legal document in which a person declares the truthfulness of the statements made.

Who is required to file sworn statement or affirmation?

Individuals who are required by law or policy to provide a truthful statement under penalty of perjury.

How to fill out sworn statement or affirmation?

You can fill out a sworn statement or affirmation by providing your personal information and the details of the statement being made.

What is the purpose of sworn statement or affirmation?

The purpose of a sworn statement or affirmation is to ensure the accuracy and truthfulness of the information being provided.

What information must be reported on sworn statement or affirmation?

The information reported on a sworn statement or affirmation can vary depending on the specific requirements, but typically includes personal details and a detailed statement.

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