AFFIDAVIT OF CHARACTER REFERENCE
STATE OF NEVADA

)
) ss.
)

COUNTY OF WASHOE

The undersigned hereby swears or affirms under penalty of perjury as follows:
4.

I __________________________________________, have personally known
(Print Name of Person Providing Reference)

______________________________________ for ________years.
(Print Name of Applicant)

5.

The nature of my relationship with the applicant is:

 Employer / employee  Family member  Friend / neighbor  Other __________________
6. I can personally attest that _______________________________ is a person of
(Print Name of Applicant)

good moral character who will be responsible and conscientious in his/her duties as a Marriage
Officiant granted the privilege of performing a marriage ceremony.
4. My contact information is as follows:
________________________________________________________________________
Residence Physical Address

City

State

Zip

________________________________________________________________________
Mailing Address

________________
Residence Phone #

City

_________________

State

Zip

_________________________________

Alternate Phone #

E-Mail Address

___________________________________________
Signature of Reference

SUBSCRIBED AND SWORN TO (OR AFFIRMED) BEFORE ME
this _______ day of _______________, 20 ______
__________________________________________
Signature of Notary Public or Deputy Clerk
(Affix County Seal or Notary Stamp)

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