Fill and Sign the Affidavit of Current Marital Status Ua Local 1 Form

Affidavit of Desertion of Spouse State of ____________County of ____________ PERSONALLY appeared before me, the undersigned authority in and for said county and state, ____________ (Name of Spouse A), who, having been being first duty sworn by the undersigned Notary Public, deposes and says: 1. I am the ____________ (wife or husband) of ____________ (Name of Spouse B), who is presently residing at ______________________________ (street address, city, county, state, zip code) or ( whose present whereabouts are unknown to affiant).2.I married ____________ (Name of Spouse B) on ____________ (date of marriage) , in ____________ (name of city and state), which marriage is evidenced by a certificate of marriage issued by ____________ (title of issuer of marriage certificate) of ____________ (name of county and/or state).3. ____________ (Name of Spouse B) and I are still lawfully married; no proceedings having been instituted to sever the bonds of matrimony.4. ____________ (Name of Spouse B), and I cohabited as husband and wife until ____________ (date of desertion), when (he/she) left our mutual residence at ____________ (street address, city, county, state, zip code). 5.____________ (Name of Spouse B) has remained separated from me ever since (his/her) departure on ____________ (date of desertion).___________________________________ Name & Signature of Spouse A SWORN to and subscribed before me, this the ____ day of _____________, 20____._____________________________NOTARY PUBLICMy Commission Expires: