By signing this form in the presence of a licensed notary at your banking institution, you acknowledge that you did

apply for an
account with Discover Financial Services and any information you provide will be used for verification of that account.
Print your name and beginning and ending bank balance amounts for the past 3 months:
jose torres
Name: ________________________________ Card Member Signature: __________________________________
01./ ___/
Date:____ 17._____
24 (773) 449-7173
Best Contact Telephone Number____________________________

Month (e.g. May 2019) Beginning Balance: Ending Balance:

Current Statement: Dic. 2023 278.82 $ 0$
Statement One Month Prior:nov 2023 326.02 $ 423.82$
Statement Two Months Prior:oct 2023 0 $ 326.02 $
U.S. and Non U.S. Citizen residing in the United States of America:
ATTN: Bank Representative: Please select the type of government issued photo ID presented by our mutual customer and provide
notary seal in the area below. If residing in California, please provide a Signature Guarantee.
U.S. Driver’s License or State ID Number: ___________________________________________

State of issuance: ________________ Exp Date: ____ / ___/ _____ DOB: ____ / ___/ _____

Visa / Passport Number: ________________________________________________________

Country of issuance: ________________ Exp Date: ____ / ___/ _____ DOB: ____ / ___/ _____

U.S. Citizen residing or traveling overseas:

ATTN: U.S. Embassy Representative: Please select the type of government issued photo ID presented by our mutual customer and
provide notary seal in the area below.
IOE9489116388
U.S. Driver’s License or State ID Number: ___________________________________________

CHICAGO Exp Date:12

State of Issuance: ________________ ____ /13
___/28 10 06 70
_____ DOB: ____ / ___/ _____
Visa / Passport Number: ________________________________________________________

Country of issuance: ________________ Exp Date: ____ / ___/ _____ DOB: ____ / ___/ _____

Active Military residing overseas:

ATTN: Military Legal Office Representative: Please complete the below and provide notary seal.
Name as it appears on the Military ID: _____________________________________________
Military ID Card Number: _______________________________________________________ Issue Date: ____ / ___/ _____

Exp Date: ____ / ___/ _____ DOB: ____ / ___/ _____

Notarizing Officer/Signature Guarantor to complete the below:

Name of Notarizing Officer/Signature Guarantor: _____________________________________
Notary Commission/Identification Number:__________________________________________

Name of Business Establishment: __________________________________________________

Street Address: _________________________________________________________________

City, State, & Zip: ________________________________________________________________

Direct Business Phone Line: _______________________________________________________

Signature Notarizing Officer: _______________________________________________________

Place Notary Stamp/Signature Guaranteed Stamp Here and/or attach any applicable documents: