Affidavit Additional Information

An affidavit (or statutory declaration) is used to record a statement of facts made by an individual.
An affidavit is typically used as evidence in court while statutory declarations are more commonly
used when dealing with government agencies, such as providing a statement as part of obtaining
an immigration visa. If you are unsure which format your statement should be in it is generally best
to go with an affidavit since statutory declarations are rarely used unless specifically requested.

IMPORTANT: Your affidavit will not become valid until you sign it in front of a notary public.

Print your affidavit after reviewing your answers for mistakes and missing information.

Sign your affidavit in front of a notary public. Sign your initials next to any
hand written portions BEFORE signing the final document.

File the signed and notarized affidavit with the court. Some jurisdictions require a
standardized backer be attached as the last page. Contact the local clerk of the
court you are filing in to ask about any backer requirements.

Affidavit Tips
• A backer exists to help court staff quickly file the document in the correct court file so it
should be attached to the back facing out. It commonly consists of:
o The style of proceedings (i.e. who is suing whom, case I.D. number, and court details);
o Your name and the date you made the affidavit;
o The number of the affidavit (in case you made multiples);
o A description of the document (i.e. “affidavit”); and
o Your contact info (i.e. name, address, phone number, and fax or email).
Generally, a backing sheet is not necessary but is considered more professional.
• You may refer to additional documents in your statement of facts and attach them as exhibits
to be submitted with the rest of your affidavit.
• Copies of the affidavit are typically given to each party involved in the suit.
• Your affidavit must include only truthful statements of facts. It is a serious offence to make a
false or misleading affidavit.
• Make sure to only include statements of fact that you have firsthand knowledge of. You
cannot include statements that you heard from a third party (this is called hearsay).
• The best affidavits avoid vague statements and are simple, consistent, and short. This makes
them easier to present and understand in court.
• Do not try to write in legalese. Clear, plain language is best. Do not include ambiguous
statements (e.g. “John Smith stated that…” is better than “John Smith left me with the
impression that…”).

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The plaintiff’s name(s) appears
first. If there are multiple plaintiffs
they are separated by using “and”.
(Listed on the case documents)
*Sample Affidavit*
UNITED STATES DISTRICT COURT The court level and jurisdiction.
FOR THE (Listed on the case documents)

DISTRICT OF COLUMBIA
John Smith and Jim Jones CIVIL ACTION NO. 1:99cv-705

The case identification number.

Plaintiff (Look in the upper right corner of the case documents)
The defendant’s name(s)
appears second. If there are
multiple defendants they are
separated by using “and”. -vs-
(Listed on the case documents)

Peter Johnson
Defendant
The name and location of the person making the
statement. This person is commonly referred to as
the affiant, declarant, or deponent.
It is recommended that you complete your
affidavit online before printing. However,
if you choose to hand write any details be
sure to sign your initials next to each written
portion. Do not hand write anything after
AFFIDAVIT the affidavit has been signed and notarized.

I, Jane Doe, of Portland, in Multnomah County, Oregon, MAKE OATH AND SAY THAT:

1. I started ABC Inc. with John Smith and Jim Jones on May 13, 2010.

2. Attached and marked as "Exhibit A" are the articles of incorporation of ABC Inc.

List one fact per paragraph so they are easier to read

and refer to.

SUBSCRIBED AND SWORN TO ) Avoid including statements that you do not have
frst-person knowledge of (e.g. heard from another
BEFORE ME, on the ) person). This is also known as hearsay.

6th day of October, 2021 )

)
)
______________________________ ) ______________________________
NOTARY PUBLIC ) Jane Doe
My Commission expires: _______________ )
This is where the person making the statement will sign
This is where the notary public will sign. in front of the notary public. Bring government I.D. to
your notarization appointment. Do not sign the
affidavit beforehand.

©2016-2021 LawDepot.com ® Page 2 of 3

 Additional Documents

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 COURT OF COMMON PLEAS OF DELAWARE COUNTY
DELAWARE COUNTY OF PENNSYLVANIA
(Court Level and Jurisdiction)

Commonwealth of Pennsylvania
CP-23-CR-0002799-2023
(Case I.D. Number)

Plaintiff

-vs-

Kahleaf Quantrell lee McCall

Defendant

AFFIDAVIT

I, Kahleaf McCall, of PHILADELPHIA, in PA County, Pennsylvania, MAKE OATH AND SAY

THAT:

1. 1.Status and Citizenship: I affirm my status as a Philadelphian, asserting that my citizenship is

rooted in the Commonwealth of Pennsylvania, distinct and separate from being a United States
citizen under the jurisdiction of the District of Columbia. This assertion is grounded in the
Constitution of the United States, ratified on June 21, 1788, which commences with the
preamble, “We the People.” This declaration embodies my affiliation and the foundational basis
of my legal standing.
2.Jurisdictional Assertion: My legal interactions and obligations are exclusively governed by the
principles of common law and Terrafirma, thereby affirming that statutory law, maritime law,
and admiralty law do not apply to my jurisdictional framework. This declaration is a reflection
of my adherence to the original constitutional principles and the traditions of common law.
3.Constitutional Rights: As a living individual with a soul who operates on land, I assert that my

Page 1 of 3
rights, particularly those enshrined in the Fifth Amendment of the United States Constitution
regarding due process, have been violated in the course of the proceedings of this case. The
denial of due process infringes upon my constitutional guarantee that no person shall be deprived
of life, liberty, or property without due process of law.
4.Distinction of Citizenship: I hereby clarify my status as a state national or state citizen of
Pennsylvania, which distinguishes me from the classification of a United States citizen as
outlined in U.S.C. Title 8 § 1401. This distinction is imperative for recognizing the unique
jurisdictional and legal standing I possess.
5.Violations of Rights and Due Process: Throughout the proceedings of this case, I was
subjected to contempt without a comprehensive understanding of the proceedings, a direct
violation of the principles of justice and due process. Such actions contravene established legal
doctrines and potentially infringe upon my rights under specific state and federal laws, which
mandate the right to a fair trial and to be duly informed of the nature and cause of accusations.
6.Lack of Probable Cause Documentation: The requisite affidavit accompanying the warrant of
arrest, essential for demonstrating probable cause as mandated by the Fourth Amendment of the
United States Constitution, was not presented to me. This omission undermines the legal basis
for any actions initiated against me based on said warrant.

Supporting Case Law:

•U.S. v. Anthony, 24 Fed. 829 (1873): Clarifies the distinction between a citizen of the United
States and a Citizen of one of the several states, highlighting the creation of a special class of
citizen by Congress.
•United States v. Cruikshank, 92 U.S. 542 (1875) and McDonel v. The State, 90 Ind. 320 (1883):
Both reinforce the existence of dual citizenship, distinguishing between citizenship of the United
States and citizenship of a state.
•Tashiro v. Jordan, 201 Cal. 236 (1927) and Kitchens v. Steele, 112 F.Supp 383: Affirm that a
citizen of the United States is a citizen of the federal government, further elucidating on the
distinct legal identities held by individuals within the framework of United States law.

Page 2 of 3
 COMMONWEALTH OF PENNSYLVANIA

COUNTY OF PA

SUBSCRIBED AND SWORN TO BEFORE

ME, on the ________ day of
_______________________________
________________, ________
(Signature)

Kahleaf McCall
Signature
_____________________________ (Seal)
NOTARY PUBLIC
My Commission expires:
______________________

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