Record Request | Crossroads

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To submit an Affidavit of Identity, Please fill out the form below, when choosing a source of identity, please upload your document.

Affidavit of Identity

First name

Last name

Last 4 digits of SSN#

Email address

Phone

Proof of Identity

Proof of Identity Upload

Choose File

The purpose of the request

I understand that falsification of this affidavit may be a criminal offence and could lead to persecution to the fullest extent of the law.

Thanks! We’ll get back with you as soon as we can..

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