Affidavit Of Review Of A Certified New Mexico Birth Certificate printable pdf download

J-0650

JF-E

EXHIBIT

Agency/Organization: GADSDEN INDEPENDENT SCHOOL DISTRICT

Dona Ana County, New Mexico

Phone (575) 882-6200

4980 McNutt Road

PO Drawer 70

Sunland Park, New Mexico 88063

Anthony New Mexico 88021

AFFIDAVIT OF REVIEW OF A CERTIFIED NEW MEXICO BIRTH CERTIFICATE

This form is to be used only by the Agency or Organization listed above to document eligibility.

Do not accept this in place of a birth certificate

This document is to verify that I have witnessed and reviewed a true and original certified copy of the CERTIFICATE OF BIRTH

issued by the State of New Mexico in accordance with Section 24-14-27 of the New Mexico Vital Statistics Act, it is unlawful for

any person to copy or issue a copy of all or part of any vital record except as authorized by law.

I, ______________________________________________________________________________________________________

Printed Name and Title of person verifying the presented certified New Mexico CERTIFICATE OF BIRTH

do hereby certify that I have witnessed an original certified State of New Mexico Certificate of Birth for:

Name of Document:

CERTIFICATE OF BIRTH, STATE OF NEW MEXICO

Name of Person Registered: _____________________________________________

Date of Birth: _____________________________________________

File No.: _____________________________________________

Date of Registration: _____________________________________________

Certificate Control No.: _____________________________________________

__________________________________________________________

________________________________

Signature of Verifier

Date

__________________________________________________________

________________________________

Name of Accepting Agency/Organization

Daytime Telephone Number

The Verifier personally appeared before me and swore or affirmed that all statements contained herein were true.

__________________________________________

___________________

________________________________

Signature of Notary Public

Date

My Commission Expires

Verifier Name, Title: This is the name of the person from your agency/organization who has witnessed the certified New Mexico Certificate of

Birth. Title is the capacity in which they are performing this duty.

Example: Jane Doe, Coach or John Doe, School Secretary

Agency/Organization: This is the organization name and county location where document was witnessed.

Example: Santa Fe City League, Santa Fe District

File Number and Date of Registration: The file number and date of registration appear on all computer generated certified copies issued since

1984. All certified copies ear the gold embossed great seal of the

State of New Mexico. To aid in the authenticity of a presented certificate, verify that the raised state sea is also visible from the back of the

certificate.

Certificate Control No.: This is the number in red located on birth certificate; the control number is a security feature that allows the ink to

“bleed through” to the back of the certificate. To aid in the authenticity of the verified document, verify that the red ink on control number is

also visible from the back of the certificate.

THIS IS NOT A BIRTH CERTIFICATE

New Mexico Vital Records and Health Statistics

Revised: 9/2003

Affidavit Of Review Of A Certified New Mexico Birth Certificate

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