(a) a statement that the declarant is a married person, and that there is in existence a judgment decreeing legal separation of the parties or an interlocutory judgment of a dissolution of the marriage between declarant and his or her spouse;

(b) a statement showing that declarant is the head of a family, as defined in this Article, if such is the case.
(c) the matters required by (a) and (b) subsections of § 43202, and in addition thereto, may contain the statement and affidavit provided for by Subsection 4 of said Section, with like effect as therein provided.
SOURCE: CC ‘1269.2, R/R by P.L. 15-113:21.