A California affidavit form is fairly straightforward, requiring basic identifying information along with the details to which you are attesting. Use a California general affidavit form to verify the facts of your case, whether for legal proceedings or business transactions.COUNTY OF LOS ANGELES } SS. I,. , living at. Include your Identity Theft Affidavit (FTB 3552) 7 when reporting. 1. My legal name is ______. I understand that the information may be subject to investigation and verification and my signature constitutes authorization for these investigations. Dear Medi-Cal Access Program,. I am providing this affidavit to verify my income as I have no other income documentation available to me. Complete and sign this application LEGIBLY using ONLY black or blue ink on the attached or downloaded form using only 8 ½" x 11" (or A4, 8.25" x 11.7") paper. Department of Public Social Services.