Nulla Osta for US Citizens

DICHIARAZIONE GIURATA – SWORN STATEMENT

REPUBLIC OF ITALY
Province and city of ____________ Legge 1195 – 13/10/1965
CONSULATE GENERAL OF THE UNITED STATES OF AMERICA Gazzetta Ufficiale 09/11/1965
(Consular Section)

1. Io, ______________________________________________ sotto vincolo di giuramento dichiaro quanto segue:
Under oath, I (NAME AS SHOWN ON PASSPORT) declare as follows:
2. Sono nato/a a _____________________________________________ il _______________________________
I was born at (place of birth: CITY, STATE, COUNTRY) on (date of birth – DD/MM/YYYY)
3. I nomi dei miei genitori sono: ______________________________ e __________________________________
The names of my parents are: (father’s FIRST & LAST name) and (mother’s FIRST & MAIDEN name)
4. Sono cittadino/a degli Stati Uniti d’America e titolare del passaporto Americano No. ______________________
rilasciato da ________________________________________________ il ______________________________
I am a citizen of the United States of America and bearer of U.S. Passport No… issued at… on (DD/MM/YYY)
5. Sono residente nello Stato di: __________________________________________________________________
I am a resident of the State of
6. Mi trovo temporaneamente in Italia al seguente indirizzo: ___________________________________________
I am temporarily residing in Italy at the following address:
7. Desidero sposare:____________________________________________________________________________
I wish to marry: (name of fiance/e AS SHOWN ON PASSPORT)
di __________________________________________ e di __________________________________________
of (father’s FIRST & LAST name) and of (mother’s FIRST & MAIDEN name)
8. Nato/a a __________________________________________________ il _______________________________
Born at (fiance/e’s place of birth: CITY, STATE, COUNTRY) on (date of birth – DD/MM/YYYY)
9. Cittadino/a ___________________________ attualmente residente/domiciliato a _________________________
Citizen of (fiance/e’s nationality) currently residing at (address in Italy)
10. Sono attualmente libero / libera (circle first word if male, second if female) di sposare e non vi è alcun impedimento legale, in base alle leggi dello Stato di cui sono residente, al mio matrimonio. I am presently free to marry and there is no legal impediment of any kind to my marriage under the laws of the State of which I am a resident.

•Sono celibe / nubile. (circle first word if male, second if female)

I am single and never married before.

•Sono divorziato / divorziata. (I am divorced)
•Sono vedovo / vedova (I am a widower/widow)

11. A testimonianza di tale dichiarazione, appongo la mia firma in calce a questo documento.
In witness thereof, I hereby affix my signature on this document.
________________________________________________

Firma (Applicant’s Signature)
Giurato e sottoscritto davanti a me il Subscribed and sworn to before me on (date) ___________________________________
Certifico che dai documenti esibitimi, ho identificato ___________________________________ e che lo/a stesso/a è cittadino degli Stati Uniti. I hereby certify that I have identified (name of US citizen) and that he/she is a US citizen.

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