Fillable Printable affidavit of marriage - Oregon State University

affidavit of marriage - Oregon State University

University Housing and Dining Services

Oregon State University, 102 Buxton Hall, Corvallis, Oregon 97331-1317

T 541-737- 4771 | F 541-737- 61 80 | http://oregons t at e.e du/uhds

Affidavit of Marriage

We, the undersigned, declare that we are legally married to each other and if requested,

would be able to provide proof of our marriage.

We certify under penalt y of perjury under the laws of the State of Oregon that the

foregoing is true and accurate to the best of our knowledge, and we understand

that the University may initiate disciplinar y action and impose sanctions against

any student who furnishes false or misleading information to the University or its

representative. OAR 576-015-0020(6).

Student or Employee: Spouse:

Printed Name Printed Name

Signature Signature

Date Date

**Note**: This affidavit is for use in providing services and benefits within the purview of

Oregon State University and is not related to employee health benefits.