Statement Of Midwife In Attendance At Birth

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Statement of Midwife in Attendance at Birth
I certify that I was the attending midwife for the birth detailed below:
Name
Date
Time of birth
Sex
Place of birth
Parents
Address
Signature
Date
Print name
Address
Commonwealth of Massachusetts
County of
On this
day of
, 20____, before me, the
undersigned notary public, personally appeared
,
(midwife)
proved to me through satisfactory evidence of identification, which was MA license,
to be the person whose name is signed on this document in my presence.
Notary Public

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