Affidavit Of Pregnancy
Download a blank fillable Affidavit Of Pregnancy in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Affidavit Of Pregnancy with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1AFFIDAVIT OF PREGNANCY
(Only needed if there is no Medical Proof of Pregnancy)
(To Establish Birth Registration for a Homebirth)
FORM MUST BE NOTARIZED
Mother of the
First Name
Middle
Last
child
Name of
First Name
Middle
Last
Witness
Address
City
Witness
Address
State
Zip Code
County
Phone Number
Witness to:
What date did you witness
How do you know the Mother?
this pregnancy/delivery
?
Saw the Mother
Pregnant
How long have you known the Mother?
Saw the Mother
From date:
/
/
Deliver
Saw the newborn
To date:
/
/
Years
Months
baby
Under penalty of perjury, I certify that the information presented in this affidavit is true and accurate to the best of my
knowledge. The undersigned further understands that providing false representation herein constitutes fraud. The
penalties for submitting a record under false pretense include a maximum fine of ten thousand dollars ($10,000), or
being found guilty of a Class 2 misdemeanor. (N.C.G.S. §130A-26.2).
Signature of Witness:
Date:
Printed Name of Witness:
NOTARY ACKNOWLEDGEMENT
State of _____________________
County of ___________________
Signed and sworn to (or affirmed)before me on this ______ day of __________, 20 _____, by __________________________________
Day
Month
Witness
(official Seal)
________________________________
______________________________,Notary Public
Official Signature of Notary
Notary’s printed or typed name
My Commission expires on:_________________________
ADVERTISEMENT
0 votes
Related Articles
Related forms
Affidavit To The Register Of Wills That No Delaware Estate Tax Return Is Required And Affidavit Of Jointly Held Real Property
Legal
Affidavit Of Consent Of Infant Of The Age Of Fourteen (14) Years Or Older - New York Supreme Court
Legal
Related Categories
Parent category: Medical