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Single Status Affidavit

I, _______________, hereby declare:

  1. I was born on ____ in ____.
  2. I currently reside at ____.
  3. I am a citizen of United States.
  4. My present civil status is SINGLE — never married.
  5. I have never entered into any prior marriage and am legally free to marry.
Affiant Signature
Notary Public Signature
Notarial Certificate (Jurat)
State of Pennsylvania
County of Philadelphia

Subscribed and sworn to (or affirmed) before me on this ______ day of ______________, 20 26, by ________________________________________.

Notary Public
Printed Name of Notary
My commission expires
Notary
Seal
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