Title: Witness Affirmation Form
Author: Teri Sahm
Last saved by: Patrick Stewart

Witness Testimony Affirming American State Political Status and Identity

This Witness Testimony verifies the identity of the man/woman shown
in this photograph to establish their political status as an American 		Place Photo here
State National or American State Citizen, depending on their choice.

Name appearing in this photo:
Physical Address:      _________________________________________
Witness: I,__________________________________________(printed name), know the lawful person shown in the photo above by the name shown, and I know of their family and history, sufficient to know that they were born at the time and place shown on the face of the referenced Birth Certificate or shown on the accompanying United States Naturalization paperwork.
My relationship to the Declarant is:
____________________________________________________________________________________
This testimony is true, complete, and correct to the best of my knowledge and I make it under Penalty of Perjury under the Public Law of The United States of America:
So affirmed this _______ day of _______________________ in the year of ___________. by:_______________________________________________
I may be contacted at: (phone) ______________________________,
(email)_________________________________________________, or at this mailing address:
____________________________________________________________________________________
Witness Verification by Recording Secretary:
South Carolina 
___________________________ County
Today, I was visited by the Witness whose signature appears above, and they were properly identified to me and they did sign this record in my presence for the purposes described above, in witness whereof I affix my signature and seal this ______ day of ___________________ in the year of ___________.
South Carolina Assembly Recording Secretary________________________________________