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To be eligible for an Arizona Travel-Compliant Driver License or Non-operating Identification license, the applicant must be a resident of or domiciled in Arizona. If the applicant cannot provide two acceptable residency documents from the list found on the Arizona Voluntary Travel ID Identification Requirements, # 40-5144, this affidavit may be used as one proof of evidence of residency in Arizona.The individual who resides at the address and certifies that the applicant resides at that address must complete section B and provide one acceptable document establishing proof of residency. The applicant must complete section A and also provide one acceptable document to establish proof of residency.A. Applicant InformationThe applicant for an Arizona driver license or identification card must complete Section A.NameResidence AddressCityStateZIP CodeI hereby certify under penalty of perjury that all statements in this application are true and correct. I agree and understand that any misstatement of material facts may cause cancellation and/or denial of my driver license or identification card. I further understand that it is a Class 2 Misdemeanor (ARS 28-3478) to knowingly falsify information, make a false statement, conceal a material fact or otherwise commit fraud in an application on a driver license application, or non-operating identification license or falsify information required by ARS 28-3165.Applicant’s SignatureDateB. Individual or Representative InformationThe individual or representative must sign Section B.Name of Individual or RepresentativeResidence AddressCityStateZIP CodeThe individual or representative for the applicant must certify and sign the following section. I certify under penalty of perjury the information submitted on behalf of the above applicant is true and correct. The applicant does live at my residence or receives services at the location listed above. I understand that according to Arizona law, it is a crime to knowingly make any false statement relating to application for a driver license or identification card.Certifier’s SignatureDateAcknowledged before me this date.Notary or MVD Agent SignatureDateCountyStateCommission Expires ................
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