.........
and until the
.......
day of
.....................
your petitioner and the respondent
lived and cohabited with each other at various places such as
.............
and lastly at
....................
4.
That the said CD has never consummated the said pretended marriage
by carnal copulation.
5.
That at the time of the celebration of your petitioner's said pretended
marriage, the said CD was and still is by reason of his impotency or
malformation, legally incompetent to enter into the contract of marriage.
(State other grounds if applicable,
e.g.,
prohibited degree, lunacy, idiocy,
etc.)
6.
That there is no collusion or connivance between the parties with
respect to the subject of these proceedings.
............
aged
...............
by occupation service
residing at
.........
do hereby solemnly affirm and say as follows:
.....................
at the
Court House at
AB
Before me
Signature
Notary
Advocate