(pursuant to MRSA 29A ¡ì1301 subsection 11 and ¡ì 1401 subsection 1)

Maine law requires a person be physically residing in Maine to be eligible for a Maine driver¡¯s license or identification card. Residence in Maine may be proven by documents such as tax returns, paystubs, utility bills or a letter from a utility company showing application for service, leases, mortgage agreements and other objective documents that show your full legal name together with a physical residential address here in Maine. However, the Bureau of Motor Vehicles understands that some individuals, for a variety of reasons, may not have any of the suggested documents available to prove that they are actually living in Maine at the time that they are applying for a Maine Driver¡¯s License. If this applies to you, you may prove that you are actually living in Maine by providing sworn statements ("affidavits") from two (2) individuals (must be at least 18 years of age) who have personal knowledge that you are living in Maine. Statements may be from employers, landlords, clergy, neighbors, school teachers, co-workers or any other individual who has had personal knowledge of you and knows that you are currently living in Maine.

* If the applicant is a minor, only one (1) affidavit is required if it is signed by the applicant¡¯s parent or guardian.

1. Complete the information on the top of the affidavit that applies to you (the "Applicant").

3. Ask the person to whom you are giving this form to read the instructions below and to fill out the form completely and return it to you when finished.

5. Return to the Bureau of Motor Vehicles office with the two (2) affidavits to apply for your Maine driver¡¯s license or identification card.

1. Answer all questions where there is a blank. If not applicable, put "N/A".

2. Print, or type or write legibly.

3. Sign and date the form.

4. You may want to make a copy of the completed form to keep for your records.

This affidavit is to confirm that _________________________________________, an individual (Name of Applicant)

whom I know personally, of ___________________________________, is physically residing in

(Applicant¡¯s street address, and city/town).

the State of Maine.

My name is _________________________________________. My birth date is ___________.

(Your full legal name) (Month/day/year)

I presently reside at __________________________ in ___________________, Maine _______

(Street address) (city/town) (zip code)

My phone numbers where I can be reached are: home:_____________; cell: ______________; work:_____________. I am usually at work from ________ a.m. / p.m. to________ a.m. / p.m.

____________________________________________________________________________.

(Check the box if same as above, or insert complete mailing address if different from your street address)

I know that the above-named applicant is residing in Maine. I know this because: _____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

(Please describe fully how you know, including, in what capacity you know the Applicant (his or her pastor, neighbor, co-worker, the town librarian who sees her/him weekly etc.) and how frequently you have contact with him or her. Attach an additional page if you need more space. Remember to sign and date any additional page(s) you might use).

Subscribed and sworn to under pains and penalties of perjury.***

Signature:________________________________________ Date:____________________