Affidavit In Support Of Establishing Parentage Page 4

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SECTION 5A.- Verification/Certification -- For Use By Other Country Only
Subject to the penalties for providing false information under the laws of
Name of country
pursuant to
, the information and facts contained in this
AFFIDAVIT IN
Order, Decree, Statute, or Regulation Providing Penalty
are true and correct to my best knowledge and belief.
SUPPORT OF ESTABLISHING PARENTAGE
Signature of Affiant
Date
If the legal citation for penalties for providing false information is not provided above, this document must be executed
before a public official authorized to administer oaths, affirmations, certifications and verifications.
(Seal)
Public Official's printed name and title
Executed before
Me this Date
Signature of Public Official
5B. Verification/Certification -- For Use By United States
Under the penalties of perjury, all information and facts contained in this
are
AFFIDAVIT IN SUPPORT OF ESTABLISHING PARENTAGE
true and correct to my best knowledge and belief.
Date
Signature of Affiant
Sworn to and signed before
Notary Public
Commission expires
Me this Date
AFFIDAVIT IN SUPPORT OF ESTABLISHING PARENTAGE-INTERNATIONAL (3/2004)
PAGE 4 OF 4

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