Affidavit of Birth
This Affidavit of Birth is executed in accordance with the laws of the state of [State]. This document serves to affirm the birth details of the individual named herein.
We, the undersigned, declare under penalty of perjury that the following information is true and correct:
- Name of Affiant: ________________________________________________
- Relationship to Child: ___________________________________________
- Name of Child: _________________________________________________
- Date of Birth: _________________________________________________
- Place of Birth (Hospital, City, State): __________________________
- Mother's Full Name: ____________________________________________
- Father's Full Name: ____________________________________________
This affidavit is executed on this ____ day of ____________________, 20____.
The information provided herein is accurate to the best of our knowledge, and we understand that any false statement made herein may subject us to penalties under the laws of the state of [State].
Signature of Affiant: ________________________________________________
Printed Name of Affiant: ____________________________________________
Address of Affiant: ________________________________________________
Phone Number: _________________________________________________
Subscribed and sworn to before me this ____ day of ____________________, 20____.
Signature of Notary Public: ________________________________________
Name of Notary Public: ______________________________________________
Notary Public License Number: ______________________________________
My Commission Expires: _____________________________________________