Affidavit Of Birth
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1AFFIDAVIT OF BIRTH
STATE OF
COUNTY OF
I,
, born in
,
aged
and currently residing at
,
in the county of
in the state of
,
being duly sworn, do hereby depose and attest that:
1. I am a citizen of this country and over the age of 18.
2. I am attesting on behalf of the Applicant,
in {his/her} application for
3. My relationship to the Applicant is
We have known each other for
years and I have direct personal
knowledge of {his/her} life.
4. The Applicant was born in
Hospital, on the date of
at the time of
5. The name of the Applicant’s parents are
and
6. This affidavit of birth is offered in lieu of a birth certificate because
AFFIANT
Subscribed and sworn to before me this
day of
20
(Notary Public),
County.
My commission expires
20
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