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I_______________________
do affirm and swear this _____
day of ______ 2001,
to have personal knowledge John Doe alien number 12345678
has been married to and residing with Jane Doe since This
I know to be true because:_________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
____________________________________
Full
Name (Print) ____________________________________
____________________________________
____________________________________
Address,
City, State and Zip Code ____________________________________
Place
and Date of Birth ____________________________________
Relationship
to John or Jane Doe ____________________________________
Signature
Subscribed
and sworn to (or affirmed) before me this __________
day of ____________
, 2001 At_________________________________________________
. My
commission expires on______________________________
. ___________________________________________________
(Signature of Notary Public or Officer Administering Oath) ___________________________________________________
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