Affidavit of Birth
This Affidavit of Birth is designed to certify the birth details of the named individual and is executed in accordance with the laws of the State of ____________________. This document serves as a sworn statement confirming the date, place, and circumstances of the birth of the individual named herein, in instances where the birth certificate is unavailable or in need of supplementation.
State of ____________________
County of ____________________
BEFORE ME, the undersigned authority, on this day personally appeared ____________________ (Affiant), who being duly sworn deposes and says:
- The Affiant's full name is _____________________________________.
- The Affiant's relationship to the person whose birth is being attested to is _____________________________________.
- The full name of the person at birth, whose birth details are being certified, is _____________________________________.
- The date of birth of the said individual is ______________________.
- The place of birth of the said individual (city, county, state) is _____________________________________.
- The names of the parents of the individual at the time of birth are:
- Mother’s full maiden name: _____________________________________.
- Father's full name: _____________________________________.
- The reason for the creation of this affidavit (e.g., lost birth certificate, supplemental documentation) is _____________________________________.
- Any additional relevant details or circumstances surrounding the birth that should be noted are:
____________________________________________________________________________________________________________________________
The Affiant affirms that the information provided in this affidavit is true and correct to the best of their knowledge, and is provided in good faith to attest to the birth details of the aforementioned individual. The Affiant understands that providing false statements under oath can lead to penalties under law.
FURTHER AFFIANT SAYETH NOT.
Subscribed and sworn to before me this ____ day of ____________, 20____.
Notary Public: _____________________________________
(SEAL)
Affiant's Signature: ________________________________
Printed Name: _____________________________________
Date: _____________________________________________