Texas Department of Human Services
|Texas Health and Human |Declaration of Informal Marriage |Form H1057 |
|Services Commission |Declaración de matrimonio informal |January 2004 |
| | | | | |
|Section I — Woman’s Information/Información de la mujer |
|Name (Last, First, M.I.)/Nombre (Apellido, nombre, inicial) |Maiden Name/ |Date of Birth/ |Social Security Number/ |
| |Apellido de soltera |Fecha de nacimiento |Núm. de Seguro Social |
| | | | |
|Address (Street, City, State, ZIP)/Dirección (Calle, ciudad, estado, código postal) |
| |
|Place of Birth (include City, County, and State)/Lugar de nacimiento (escriba la ciudad, el condado y el estado) |
| |
| | | | | |
|Section II — Man’s Information/Información del hombre |
|Name (Last, First, M.I.)/Nombre (Apellido, nombre, inicial) |Date of Birth/ |Social Security Number/ |
| |Fecha de nacimiento |Núm. de Seguro Social |
| | | |
|Address (Street, City, State, ZIP)/Dirección (Calle, ciudad, estado, código postal) |
| |
|Place of Birth (include City, County, and State)/Lugar de nacimiento (escriba la ciudad, el condado y el estado) |
| |
| |
|Section III — Declaration/Declaración |
| |
|I solemnly swear (or affirm) that we, the undersigned, are married to each | | |Juro (o afirmo) solemnemente que nosotros, los suscritos, estamos casados el |
|other by virtue of the following facts: On or about ____________ we agreed to| | |uno con el otro en virtud de lo siguiente: más o menos el ____________ |
|be married, and after that date we lived together as husband and wife and in | | |decidimos estar casados y después de esa fecha vivimos juntos como marido y |
|this state we represented to others that we were married. Since the date of | | |mujer y en este estado dimos a entender ante otras personas que estábamos |
|marriage to the other party I have not been married to any other person. This| | |casados. Desde la fecha de mi unión con la otra persona, no me he casado con |
|declaration is true and the information in it which I have given is correct. | | |nadie más. Esta declaración es verdadera y la información dada por mí aquí es |
| | | |correcta. |
|I understand that this can be used as evidence that we were married if a | | | |
|dispute arises over whether we were married. | | |Comprendo que esta declaración se puede usar como prueba de que estábamos |
| | | |casados si surge algún conflicto sobre si hubo matrimonio o no. |
| | | | | | |
|Signature/Firma | |Date/Fecha | | |Signature/Firma | |Date/Fecha |
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