Single Status Affidavit Ver A. Affidavit of Single Status. Date. I,. , residing at. Name
of Affiant ... I am currently single, have never been married,. (or was ...
Affidavit of Single Status Date _______________________ I, __________________________________________________ , residing at Name of Affiant
personally appeared before the undersigned notary public, and under oath or affirmation make the following statements: I was born on _________________ at _________________________________________ , (date)
(city and country)
I am a citizen of____________________________________________________________ . (country)
My passport number is
,
I am currently single, have never been married, (or was divorced/widowed on _______________ and have never been remarried since that date). (date)
_______________________________ Date: _______________ Signature of Affiant
------------------------------------------------------------------------------------------------------------------------------------------State of Georgia County of _________________ Signed and sworn to (or affirmed) before me on ____________________ Date
by ________________________________________________________, Printed name(s) of individual(s) making statement
who proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me. ____ Personally Known or ____ Produced Identification Type of ID ____________________________________
_______________________________ Signature of notary public
_______________________________ (Name of notary, typed, stamped or printed)
Notary Public State of Georgia My commission expires: ___________
