Parental Affidavit Of Birth printable pdf download

Parental Affidavit Of Birth

PARENTAL AFFIDAVIT OF BIRTH

I, _____________________________________, do hereby swear that I am a parent

(Parent’s Name)

of ____________________________________________________.

(Child’s Legal Name: First, M.I., Last)

The other parent’s name is ___________________________________.

Further, I swear that the above-named child was born on ____/____/____

(Mo) (Day) (Yr)

at __________________________________. The child’s mother’s maiden name

(Place of Birth)

is ___________________________________. The attending physician at the birth

was ________________________________.

IN WITNESS WHEREOF I have hereunto signed my name this

_______ day of _______________, 19____.

______________________________

(Parent’s Signature)

______________________________

(Relationship)

STATE OF ALASKA

)

) SS

___________________JUDICIAL DISTRICT

)

I, __________________________________________, being first duly sworn, depose and say:

I am the person above named; I have read the foregoing Parental Affidavit of Birth and understand

the contents thereof; I have executed it freely and voluntarily for the purpose set forth therein; and I verify

the same is true of my own knowledge.

____________________________________

(Notary Public’s Signature)

SUBSCRIBED AND SWORN to before me this __________ day of ________________, 19_____.

_______ ____________________________

(Notary Public in and for Alaska)

My commission expires: _______________

Parental Affidavit Of Birth