Affidavit of Single Status
I ______________________________residing at ___________________________________ __
personally appeared before the undersigned notary public, and under oath or affirmation make
the following statements:
I was born on ___________ at _______________. I am a citizen of ______________________
My passport number is ________________. I am currently single, have never been married (or
was divorced/widowed on ______________________and have never been remarried since).
X ______________________________________ ____________________________
Signature of Affiant Date:
State of ___________________ )
) ss:
County of __________________ )
Sworn to (or affirmed) and subscribed before me this _____ day of ______________, 20_____
by ___________________________________________________ who proved to me on the basis of
satisfactory evidence to be the individual who appeared before me.
__ Personally Known or ___ Produced Identification
WITNESS my hand and official seal.
_____________________________________
Notary Public Signature
