With the Armed Forces | ) | ||||||
of the United States | ) | ss | |||||
at ______ | ) | ||||||
On this ______ day of ______, A.D. 20______, before me, a commissioned officer of the Armed Forces of the United States, on active duty therewith, personally appeared ______, a member of the Armed Forces of the United States, on active duty therewith, (and ______, (his wife, her husband),) to me known to be the person described in and who executed the foregoing instrument, and acknowledged that ______ executed the same as ______ free act and deed. (The said ______ declared ______ to be single and unmarried.) | |||||||
IN TESTIMONY WHEREOF, I have hereunto set my hand and grade (serial number, branch of service, and permanent mailing address). | |||||||
(Signature) | Serial Number | ||||||
______________________________________________________ | |||||||
(Grade) | (Branch of Service: Army, Navy, etc.) | ||||||
______________________________________________________ | |||||||
(Permanent mailing address) | |||||||
______________________________________________________ |
§ 442.160, RSMo
Effective 6/12/1991