Affidavit of Birth
This Affidavit of Birth is made in accordance with the laws of [State], specifically referencing the relevant sections of the state’s Vital Records laws. This document serves to affirm the birth of the individual named herein.
Details of the individual are as follows:
- Affiant's Full Name: ____________________________
- Affiant's Address: ____________________________
- Affiant's Phone Number: ____________________________
Details of the child are as follows:
- Child's Full Name: ____________________________
- Date of Birth: ____________________________
- Place of Birth: ____________________________
Certification of Birth:
I, the undersigned Affiant, do hereby declare the following to be true:
- The child listed above was born on the date and at the location specified.
- I am the legal guardian or parent of the child and have personal knowledge of the facts contained in this affidavit.
- This affidavit is executed to secure a record of the child's birth for all necessary legal and administrative purposes.
By signing this affidavit, I acknowledge that any false statements made herein may subject me to penalties under law.
Signed this _____ day of __________, 20___.
Affiant's Signature: ____________________________
Printed Name: ____________________________
Witnessed by:
- Witness's Full Name: ____________________________
- Witness's Signature: ____________________________