Affidavit of Birth
This Affidavit of Birth is executed under the laws of the [State Name], pursuant to the provisions governing the establishment of birth records.
I, [Affiant's Full Name], residing at [Affiant's Address], being duly sworn, hereby declare and affirm the following:
- I was born on: [Birth Date]
- My place of birth is: [Place of Birth]
- My parents are:
- Mother's Full Name: [Mother's Name]
- Father's Full Name: [Father's Name]
This affidavit is offered to affirm the facts surrounding my birth, which has not been documented officially through state birth records. I affirm that all of the information provided herein is true and accurate to the best of my knowledge.
In witness whereof, I have hereunto set my hand this [Date].
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Signature of Affiant
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Printed Name of Affiant
Subscribed and sworn before me this [Date].
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Signature of Notary Public
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Printed Name of Notary Public
My Commission Expires: [Commission Expiration Date]