18 U.S.C § 2257 Record Keeping
NOTE: THIS DOCUMENT TO BE KEPT SEPARATE FROM ALL OTHER RECORDS
A. I, the MODEL, understand that all the information required by this document is required to comply with United States federal law and any false statement or misrepresentation is a crime under United States law.
B. Two forms of identification, including at least one government issued photo ID, are preferred. Describe each, including number. Clear photos/photocopies of your government ID must be uploaded or otherwise provided.
ID 1 Type
ID 2 Type
C. MODEL Information:
Is MODEL a US citizen -OR- does MODEL have a US green card?
(If “yes”, U.S. government-issued identification MUST be used in section “B” above.)
D. I have also used the following names, stage names, aliases, nicknames and married and/or maiden names:
MODEL’S SWORN STATEMENT: Pursuant to 28 U.S.C. § 1746 and the penalties of perjury, under the laws of the United States, I swear that the above is true and correct and that the ID(s) which I have provided was/were lawfully obtained by me and has/have not been forged or altered.
PRODUCER’S / PHOTOGRAPHER’S 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 MODEL’s ID containing the date of birth set forth above, that I have personally questioned the Model regarding the answers given in this document, and that I have observed that Model execute this document. In addition, I swear that the date set forth below is the date on which production involving this model occurred.
Name of Producer: Appeal Photography, LLC
Leave this empty:
Signed by David Guggenheim
Signed On: January 30, 2020
If you have questions about the contents of this document, you can email the document owner.
Document Name: 18 U.S.C § 2257 Record Keeping
Agree & Sign