Fillable Printable Affidavit of Marriage - Western Oregon University

Affidavit of Marriage - Western Oregon University

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 penalty 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 disciplinary action and impose sanctions against

any student who furnished 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 Western Oregon University Housing and is not related to employee health benefits.