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2921.13.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},277966,1790220726,{"code":4,"msg":82,"data":83},"success",[84,89,94,99,104,109,114,118,123],{"id":85,"doc_module":22,"doc_module_name":25,"category_name":86,"show_sort_weight":87,"slug":88},11,"Presentations",90,"presentations",{"id":90,"doc_module":22,"doc_module_name":25,"category_name":91,"show_sort_weight":92,"slug":93},12,"Resumes",80,"resumes",{"id":95,"doc_module":22,"doc_module_name":25,"category_name":96,"show_sort_weight":97,"slug":98},14,"Invoices",70,"invoices",{"id":100,"doc_module":22,"doc_module_name":25,"category_name":101,"show_sort_weight":102,"slug":103},15,"Posters",60,"posters",{"id":105,"doc_module":22,"doc_module_name":25,"category_name":106,"show_sort_weight":107,"slug":108},16,"Social 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an Ohio street address through documents listed on the Ohio BMV Acceptable Documents List.  \n􀁸 A dependent child may have an address confirmed by a parent or guardian who has proof for the same address.  \n􀁸 A married person may have an address confirmed by a spouse who has proof for the same address.  \n􀁸 An Applicant may have the address confirmed by an appropriate Agency (homeless shelter, nursing home, half-way house, faith-based institution, or other legitimate social services agency) whose authorized agent confirms the address listed.  \nPLEASE TYPE OR PRINT ALL INFORMATION LEGIBLY. ALL FIELDS ARE REQUIRED, EXCEPT WHERE NOTED. (*)  \n\n| APPLICANT’S FIRST NAME | MIDDLE NAME OR INITIAL |  | LAST NAME |  | DATE OF BIRTH |  |\n| --- | --- | --- | --- | --- | --- | --- |\n| OHIO STREET ADDRESS |  | CITY |  | STATE\u003Cbr>OHIO |  | ZIP CODE |\n\nI certify that I am the person described above, that I am a permanent resident of the state of Ohio, that I do not have documentary proof for the above street address, that I am authorized to use the above address to receive mail and legal notices, and that I request that the address be entered as my address on any Ohio driver license or Ohio ID issued to me.  \nAPPLICANT’S SIGNATURE:  X  DATE:    \nCERTIFICATION BY PARENT OR GUARDIAN OF DEPENDENT CHILD OR SPOUSE OF MARRIED APPLICANT  \n\n|  PARENT OR STEP-PARENT  GUARDIAN  SPOUSE |  |  |\n| --- | --- | --- |\n| FIRST NAME | MIDDLE NAME OR INITIAL | LAST NAME |\n\nI certify that I am the parent, stepparent, guardian, or spouse of the applicant as indicated above, that the applicant is a permanent resident of the state of Ohio, that my address and the applicant’s address are the same, and that I have presented documentary proof of my Ohio resident street address.  \nPARENT / GUARDIAN / SPOUSE SIGNATURE:  X  DATE:    \nOR CERTIFICATION BY SOCIAL SERVICES AGENCY (IF NO PARENT, GUARDIAN, OR SPOUSE CERTIFICATION)  \n\n| NAME OF AGENCY |  |  |  |\n| --- | --- | --- | --- |\n| DESCRIBE NATURE OF AGENCY (HOMELESS SHELTER, NURSING HOME, HALF-WAY HOUSE, FAITH-BASED INSTITUTION, ETC. ) |  |  |  |\n| ADDRESS OF AGENCY | CITY | STATE | ZIP CODE |\n| NAME OF AUTHORIZED AGENT | TELEPHONE NUMBER\u003Cbr>( ) - | *FAX NUMBER OR EMAIL ADDRESS (Optional)( ) - |  |\n\nI certify that I am an authorized agent of the above Agency, that the Applicant described above is a client of or is known to the Agency, that to the best of my knowledge and belief the applicant is a permanent resident of the state of Ohio, that the applicant does not currently have documentary evidence of a permanent street address, but that the applicant can receive mail and legal notice at the address listed above.  \nAUTHORIZED AGENT’S SIGNATURE:  X  DATE:    \nWARNING: This document is part of an application for a state license or ID. Making a false statement on this document may constitute the crime of falsification, a misdemeanor of the first degree, RC 2921.13.  \n\n| BMV USE ONLY (VERIFICATION) |  |\n| --- | --- |\n| AGENCY CONFIRMATION | DATE |\n| PROOF PRESENTED BY PARENT / GUARDIAN / SPOUSE |  |\n| D/R EMPLOYEE | MANAGER OR DEPUTY REGISTRAR |","cbCaimFw2iKR7BTy","https://ap.wps.com/l/cbCaimFw2iKR7BTy","pdf",101213,"English","# Applicant Information\n## Certification Signatures\n### Parent/Guardian/Spouse Certification\n### Social Services Agency Certification\n# Warnings and BMV Use Only","[{\"question\":\"When is the Proof of Ohio Residency-Certified Statement required?\",\"answer\":\"It is required when an applicant for an Ohio driver’s license or Ohio ID cannot provide proof of an Ohio street address using documents listed on the Ohio BMV Acceptable Documents List.\"},{\"question\":\"Who can certify an applicant’s address if the applicant lacks documentary proof?\",\"answer\":\"A parent or guardian can certify for a dependent child, a spouse can certify for a married applicant, or an appropriate authorized agency (such as a homeless shelter or nursing home) can certify the address.\"},{\"question\":\"What happens if false information is provided on the form?\",\"answer\":\"Making a false statement may constitute the crime of falsification, a misdemeanor of the first degree under RC 2921.13.\"}]","Proof of Ohio Residency-Certified Statement | PDF",1789505844]