The original, notarized Residency Affidavit Form must be presented at the meeting. How to fill out the Residence Verification Form Harris Health?1. Enter client and household member information. 2. Doubled-up families do not need to submit this form. Section A: STUDENT INFORMATION – Please print clearly in ink. A residency affidavit is a sworn, notarized statement confirming your residence address. You might need one for a driver license or identification card renewal. This document contains protected and confidential patient health information and must be secured at all times while in use. All applicants must present ONE of the following documents. Applicant's name and Harris County residential address must be on the document.