Affidavit of Marital Status for Brazilian Citizens

Declaration of Marital Status

We, the undersigned, hereby declare as a matter of fact and under penalty of law that we know Mrs. Daniela Rodenas (Brazil), bearer of passport No. 366,704-HP (valid until 13 March 2012), residing at 24 Rue Victor Basch, 92120, Montrouge, Paris, France. We confirm that her marital status to date is single, with no legal impediments to marriage according to Brazilian legislation.

Declarant Information

• 1. Declarant
  • Name:
  • Occupation:
  • Birthplace:
  • Status:
  • RG No:
  • Passport No:
  • Address:
  • Signature:
• 2. Declarant
  • Name:
  • Occupation:
  • Birthplace:
  • Status:
  • RG No:
  • Passport No:
  • Address:
  • Signature:

Paris, France; ____ / ____ / 2010

Legal Notice

Brazilian Penal Code (Art. 299): "Omitting in a public or private document a declaration that it should contain, or inserting or causing to be inserted a false statement that should have been written, in order to prejudice a right, create an obligation, or alter the truth regarding a legally relevant fact."

Penalty: Imprisonment for 1 to 5 years.