7/17/2019 DACA Basic Affidavit

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AFFIDAVIT OF __________________ 

 

1. My name is __________________________. My address is _______________ 

 _______________________________. My telephone number is _____________.

2. I personally know ene Vas!ue" be#ause ___________________________ 

 _______________________________________________________________ 

 _______________________________________________________________ 

 _______________________________________________________________

$. I know ene Vas!ue" was in the %nited &tates at the 'ollowin( times)

 _______________________________________________________________.

I know this be#ause_______________________________________________ 

 _______________________________________________________________ 

 _______________________________________________________________ 

 _______________________________________________________________.

I de#lare under penalty o' per*ury that the #ontents o' this statement are true

and #orre#t to the best o' my knowled(e and belie'.

si(nature) _________________________

date) ____________________

+rint ,ame)