Figure: 25 TAC §139.41(a)(8)(A)

Affidavit

I, ______________________________, swear or affirm that my date of birth is ___________________, ______ , and that I do not have appropriate identification that states my date of birth.

                                                                        Signature: ____________________________

                                                                        Printed name: _________________________

Witness: ________________________________________

Printed name of witness: ___________________________