Identification Notary Form
Identification (unexpired government-issued identification evidencing nationality or residence and bearing a photograph or similar safeguard):
q Drivers License, Issue date / Expiration date
q State Issued ID
q Other ______________________________
q Signature Card
Identification Box (photocopy identification document in this box).
(photocopy identification document in this box)
For U.S. person, a U.S. taxpayer identification number (e.g. Social Security number, individual taxpayer identification number, or employer identification number); for non-U.S. persons, one or more of the following: a U.S. taxpayer identification number, passport number and country of issuance, alien identification card number, or number and country of issuance of any other government-issued document evidencing nationality or residence and bearing a photograph or similar safeguard
Identification Number: ___ ___ ___ - ___ ___ - ___ ___ ___ ___
I, _____________________________, certify that this is my appropriate social security number and current identification.
__________________________________________ _______________________________
Customer Signature Date
USA Patriot Act
Important Information About Opening a New Account:
To help the government fight the funding of terrorism and money
laundering activities, Federal law requires all financial institutions to
obtain, verify and record information that identifies each person who
opens an account.
What this means for you:
When you open an account, we will ask for your name, address, date
of birth and other information that will allow us to identity you. We
may also ask to see your driver’s license or other identifying documents.