U.S.C. 2257

18 U.S.C. § 2257 Records Keeping for Models

Model attestation
NOTE

This form requires FRONT and BACK scanned images of your identification document. Please have those images ready to upload. You can use your mobile camera to take photos of your ID. Keep both front and back images handy and upload them when asked below.
(A) I, (full legal name)*

First NameLast Name
Valid Email (completed form will be e-mailed to this):
example@example.com
(“Model”), understand that the information required by this document is required to comply with the United States federal law and any false statement or misrepresentation is a crime under United States law. (B) A government issued photo Identification is required. Describe below, including number. Clear photocopies of each must be attached and the photocopies must be signed in ink by the artist.
Form of identification*
Identification Number: ID
Birthdate*

MonthDayYear
Date
Ageblanks
Front of Identification Document*
Back of Identification Document*
(C) I have also used the following names, stage names, aliases, nicknames and married and/or maiden names (if any):
First Name Last Name
First Name Last Name
MODEL’S SWORN STATEMENT: I, 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.*

MonthDayYear
Today's date
I understand and accept that my electronic signature will be as valid as a hand written signature and considered original to the extent allowed by applicable law. Model's Signature using full legal name*

Clear
Producer's Section

(Leave blank for producer/photographer to complete)
Name of Producer
Date of production

MonthDayYear
Date
Location of production: Lockport, NY
Producer's signature

Clear
NOTE: THIS DOCUMENT TO BE KEPT SEPARATE FROM ALL OTHER RECORDS
Should be Empty:

18 U.S.C. § 2257 Records Keeping for Models

NOTE

Producer's Section

NOTE: THIS DOCUMENT TO BE KEPT SEPARATE FROM ALL OTHER RECORDS