Statutory Declaration of Single Status

STATUTORY DECLARATION OF SINGLE STATUS

On this date of ______I, ______residing at ______do solemnly and sincerely declare that the information given here is true. I am a Single ______and have never been married.

{ or I am Single ______however I was married but I am now divorced ______. }

I was born on ______& in ______in the ______in ______.

My fathers name is ______, My mother’s name is______

I am a citizen of ______. My passport number is ______was issued on ______in ______, ______. We plan to get married in ______.

My Fiancé(e)'s ______and his/her nationality is ______.

His/Her Date of birth ______

His/Her fathers name is ______his/her mother’s is______.

And they reside at ______.

Place of birth ______.

My e-mail address is ______.

To the best of my knowledge and belief there is no legal impediment or other lawful cause to prevent me from getting married.

______

Affiant’s signature

State of New York / )
) / ss.:
County of ______/ )

Sworn to before me this______day of ______, 20 ______, the undersigned notary public, personally appeared______

proved to me through satisfactory evidence of identification, which were ______,

to be the person(s) whose name is (are) signed on the preceding or attached document and who swore or affirmed to me that the contents of the document are truthful and accurate to the best of (his) (her) (their) knowledge and belief.

______

(notarial signature and seal of notary public)

My Commission Expires ______

Fiancé = Man, Fiancée = Female