Affidavit of Birth
This Affidavit of Birth is executed in accordance with the laws of the state of [State Name]. It serves as a declaration of the birth of a child, providing necessary information for verification purposes.
I, [Your Full Name], residing at [Your Address], hereby declare as follows:
- Child’s Name: [Child's Full Name]
- Date of Birth: [Child's Date of Birth]
- Place of Birth: [City, County, State]
- Mother’s Name: [Mother's Full Name]
- Father’s Name: [Father's Full Name]
This affidavit is made for the purpose of establishing the birth of the above-named child. The information contained herein is true and correct to the best of my knowledge and belief.
Further, I understand that providing false information in this affidavit can lead to legal penalties.
Signed this [Date] day of [Month, Year].
______________________________
[Your Signature]
[Your Printed Name]
[Your Title, if applicable]
If applicable, the signature must be notarized below:
State of [State Name]
County of [County Name]
On this [Date] day of [Month, Year], before me personally appeared [Your Full Name], known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to this affidavit.
______________________________
[Notary Public’s Signature]
[Notary Public’s Printed Name]
[Notary Public’s Commission Number]
My commission expires: [Expiration Date]