Visit us at www.njmvc.gov
New Jersey is an Equal Opportunity Employer
AFFIDAVIT OF NO SOCIAL SECURITY NUMBER OR INDIVIDUAL TAXPAYER ID NUMBER
STANDARD DRIVER LICENSE OR NON-DRIVER IDENTIFICATION CARD ONLY
I,
born on
affirm the following:
(print full legal name)
(month/day/year)
• I have never been issued a Social Security number;
• I am not eligible for a Social Security number; AND
• I have never been issued an Individual Taxpayer Identification Number.
By signing this affidavit, I declare that the above information is true to the best of my knowledge. I am aware
that if any of the information provided by me is willfully false, I am subject to punishment.
Applicant signature
Date
DO NOT SIGN until in front of a Notary Public OR a Witness (over 18 years old).
Choose A or B below.
OPTION A
ACKNOWLEDGMENT BY NOTARY PUBLIC:
STATE OF NEW JERSEY )
) SS:
COUNTY OF
)
On
, 20
, before me personally appeared
, who
signed this document in my presence and who has satisfactorily identified him/her/themselves as the signer of
this document.
Notary Name
[Affix Notary Stamp here]
My Commission
Expires
Notary Signature
OPTION B
FOR MVC USE ONLY: I personally witnessed ________________________________ sign this affidavit.
_____________________________
MVC Employee Initials/Date
_____________________________
MVC Agency
