I, the undersigned, make oath and declare the following information regarding my marriage to be held in the city ("Comune") of ______________________________ approximately on the _____ day of ______________, 20___:
1. that I am a Canadian Citizen
__ by birth OR
__ by naturalization
2.that I am the bearer of Canadian Passport number _____________ issued at _______________ on ___ / ___ / 20___, where my personal information appears as follows:
Last name(s): __________________________________
Given name(s): __________________________________
Date of birth: __________________________________
Place of birth (city and country): __________________________________
3. that my parents are/were:
Father’s last name(s): __________________________________
Father’s given name(s): __________________________________
__ living __ deceased
Mother’s last name(s) at birth (maiden): __________________________________
Mother’s given name(s): __________________________________
__ living __ deceased
4. that my current residential address is:
_____________________________________________________________________
_____________________________________________________________________
5. that, if different, my last address in Canada was
_____________________________________________________________________
_____________________________________________________________________
6. that I am the holder of the long-form Canadian birth certificate no. ________________ issued by the Province/Territory of ________________ on ___ / ___ / _____
OR
that I am the holder of the Certificate of Canadian Citizenship number __________________ issued on ___ / ___ / _____
7. that I am free to marry as I am
__ single and never previously married
__ widowed; indicate the full name of the spouse, as well as the date and place of death
____________________________________________________________
__ divorced; indicate the full name of the ex-spouse, as well as the details of the final divorce decree
____________________________________________________________
8. that I intend on marrying the following person:
Last name(s): __________________________________
Given name(s): __________________________________
Date of birth: __________________________________
Place of birth (city and country): __________________________________
Father’s last name(s): __________________________________
Father’s given name(s): __________________________________
__ living __ deceased
Mother’s last name(s) at birth (maiden): __________________________________
Mother’s given name(s): __________________________________
__ living __ deceased
9. that this person’s current residential address is:
_____________________________________________________________________
_____________________________________________________________________
10. that my telephone and/or cell phone number, as well as e-mail address, are:
Home: __________________________________
Cell phone: __________________________________
E-mail: _______________________@__________________________
11. that the person I intend on marrying (per item 8 above) and I are not related either by blood or marriage (article 87 Codice Civile)
12. that neither I nor the person I intend on marrying (per item 8 above) have ever been convicted for the attempted or successful murder of the other person’s former spouse(s) (article 88 Codice Civile)
Attached to this affidavit are true certified copies of
and, if applicable
__________________________
(signature of the affiant)
SWORN, DECLARED and SIGNED before me at _____________________________ this ______ day of ____________, 20__.
________________________________
(signature and seal of a notary public or consular officer)