CERTIFICATE OF NON IMPEDIMENT AFFIDAVIT



I swear that I, ___________________________________ I am Single ________and I have never been married. I was born on __________ & in ___________ in the ____________ in ________.

I was previously married but I am now divorce ______________________

My fathers name is ______________________, my mother’s name is____________________

I am a citizen of _____________________.

My passport #___________ 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 _______________ |)|  |

|  |)|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)

My Commission Expires _____________________

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