Affidavit of Birth
This Affidavit of Birth is prepared to assert the facts surrounding the birth of an individual. It is used in instances where a birth certificate is unavailable or for the purpose of confirming personal details for official documents. The information provided must comply with state laws if the affidavit is state-specific.
STATE OF ____________________
COUNTY OF __________________
BEFORE ME, the undersigned authority, on this day personally appeared ______________________ (Affiant), who being duly sworn, deposes and says:
- Full Name of the Person of Birth: _____________________________________________
- Date of Birth: _____________________________________________________________
- Place of Birth (City, County, State, Country): _____________________________________________________________________
- Full Name of Father: _______________________________________________________
- Full Name of Mother: ______________________________________________________
- Your relationship to the Person of Birth: ________________________________________
- Detailed Reason for this Affidavit: ______________________________________________________________________
- Any Additional Information or Facts: _________________________________________________________________
I, ________________________ [Affiant’s Name], swear or affirm, under penalty of perjury, that the foregoing statements are true and correct to the best of my knowledge.
Executed this ______ day of ______________, 20____.
Affiant’s Signature: _________________________________
Printed Name: _______________________________
Subscribed and sworn to (or affirmed) before me this ______ day of ______________, 20____, by ______________________ [Affiant’s Name], proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me.
Notary Public Signature: __________________________________
Printed Name: ________________________________________
Commission Number: ______________________________
My Commission Expires: ___________________________