18 U.S.C. § 2257 Records Keeping for Performers
(1) First form of identification: (2) Second form of identification:
Birth Date: _____________________________(Month/Day/Year) Age: __________
(1) _____________________________ (2) _____________________________
(3) _____________________________ (4) _____________________________
If more than 4 please attach a separate sheet, signed by the performer, with all names.
PERFORMER'S SWORN STATEMENT:
I, ______________________________ (full legal name) pursuant to 28 U.S.C. §1746 and the penalties of perjury, under the laws of the United States, swear that the above is true and correct and that the ID which I have provided, a copy of which is attached and signed by me, was lawfully obtained by me and has not been forged or altered.
Today's Date: _____________________________
Performer's Signature (using full legal name)
WITNESS' SWORN STATEMENT:
Pursuant to 28 U.S.C. §1746 and the penalties of perjury, under the laws of the United States, I swear that I have personally examined the Performer’s ID containing the age of birth set forth above and I have observed the Performer execute this document and sign the attached copy of the ID.
Witness’s Signature Print Witness's Name
NOTE: THIS DOCUMENT TO BE KEPT SEPARATE FROM ALL OTHER RECORDS