STATE OF:
COUNTY OF:
I, (hereinafter "Affiant"), being duly sworn, hereby depose and state as follows under penalty of perjury:
1. IDENTITY DECLARATION
My full legal name as it appears on my government-issued identification is:
(Legal Name)
2. PSEUDONYM DECLARATION
I am the sole creator and author of literary works published under the pen name/pseudonym:
(Pseudonym/Pen Name)
3. OWNERSHIP AND RIGHTS
I hereby affirm and declare that:
- I am the original author and copyright owner of all works I publish under the above pseudonym;
- I have the legal right to publish and monetize said works;
- No other person has claim to the pseudonym in connection with my literary works;
- I am solely responsible for all content published under this pseudonym.
4. PLATFORM AUTHORIZATION
I authorize AuthorMind Hub ("the Platform") to:
- Display my works under my pseudonym ;
- Process payments to my legal name for royalties earned under my pseudonym;
- Verify my identity for legal and financial purposes while maintaining public anonymity;
- Share my legal name with law enforcement or courts if legally required.
5. CONTACT INFORMATION
Email Address:
Phone Number:
Mailing Address:
6. TRUTHFULNESS STATEMENT
I declare under penalty of perjury under the laws of the State of that the foregoing is true and correct to the best of my knowledge and belief.
Signature of Affiant (Legal Name)
Date
Printed Legal Name
Notary Public Section
(To Be Completed by Notary)
Subscribed and sworn to (or affirmed) before me on this day of , 20 , by , who proved to me on the basis of satisfactory evidence to be the person who appeared before me.
Signature of Notary Public
Printed Name of Notary Public
My Commission Expires:
[NOTARY SEAL/STAMP MUST BE PLACED HERE]
For AuthorMind Hub Use Only:
Document Received: _______________
Verified By: _______________
Date: _______________