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

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