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Statement on being
not married

  To whom it may concern
From Ivan Ivanov, citizen of the Russian Federation,
date of birth 00.00.0000, sex: male
resident at: Moscow, __________________________
passport series 00 00 000000 issued on 00.00.0000
by Internal Affairs Department of "_________________"district of ________
subdivision code 000-000


STATEMENT

I, Ivan Ivanov, by this statement inform that I am not married at the moment.

Contents of the article 34, 35 of Family Code of the Russian Federation were explained to me by the notary.

Signature_________________________________

Moscow.

Date ________________________________ .

This statement is attested by me, Sidor Sidorov, notary of Moscow.

The statement is signed by Ivan Ivanov in my presence. His identity is proven, active capacity is checked. Marital relationships are checked.

Recorded in the register under No. 0-0000.

Charged according to the tariff: 00 roubles 00 kopecks

Attested in the notary public office located at:___________________.

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