AFFIDAVIT TO SINGLE STATUS FACTS
I, ( ), the undersigned, after
being duly sworn, do depose and testify:
1. That I am a citizen of the Republic of China, holder of
ID. Card No. , born on , , .
2. That I married ( )
on and divorced on .
3. That I am now legally free to marry.
4. That I have census record in Taiwan, and presented here with an
Extract of Household Registration as evidence to the aforesaid facts.
Further the Affiant saith not.
Subscribed and acknowledged before me on the day of ,
2003, at the Wu, Shuo-Ren Notary Public Office, Taiwan Taipei District
Court, the Republic of China.