Single Status Affidavit Ver D.docx

Affidavit of Single Status

I, __________________________________________________ , residing at

Name of Affiant

________________________________________________________________________

(street) (city) (state) (postal code)

personally appeared before the undersigned notary public, and under oath or affirmation make

the following statements:

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

____ proved to me on the basis of satisfactory evidence to be the person

who appeared before me.

_______________________________

(signature of notary public)

Notary Public, State of Georgia Stamp/Seal

My commission expires: ___________