AFFIDAVIT OF __________________________

The undersigned, being duly sworn, deposes and says.

1. I am over the age of 18, and believe in the obligations of an oath.
2. My full name is ___________________________________________________________
3. I reside at
________________________________________________________________________
________________________________________________________________________

4. My date of birth is ______________________________________, and my place of birth is

________________________________________________________________________

5. My relationship to
________________________________________________________________________
is as follows: _____________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

6. I hereby testify that the relationship of

________________________________________________________________________
________________________________, is authentic, and that their marriage is bona fide.
I affirm under the penalties for perjury that the above- listed facts are true to best of my
knowledge

___________________________ _________________________
Date