Transcription of Affidavit of Single Status - One Source Process
1 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_____.
2 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 Signatur
