| [Name] |
| [Address] |
| [City, State, Zip] |
| [Phone] \ [Email] |
| To whom it may concern: |
| | | | | | | | | | |
| I, [Your Name], born in United States on [Date of Birth] certify with my three original signatures below, that this is a true and accurate copy of my valid U.S. Passport and valid Identification. Above is my current home address, telephone number, and email address. |
| |
| [Please Upload License] | [Please Upload Passport] |
| Three original singatures: |
| (1) Signature:___________________________________ |
| Date:___________ |
| (2) Signature:___________________________________ |
| Date:___________ |
| (3) Signature:___________________________________ |
| Date:___________ |
| |
| For Notary Public |
| |
| State of ____________________________ |
| County of ____________________________ |
| On this, the___________day of ______________, 20______, before me a notary public, the undersigned officer, personally appeared_____________________________, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein contained. |
| |
| In witness hereof, I hereunto set my hand and official seal. |
| |
| Notary Public ______________________________________ |