One more Sample for Affidavit of Birth
One more sample which was given by my attorney.
SAMPLE AFFIDAVIT OF BIRTH
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U.S. laws require submission of copies of birth certificate given by the LOCAL GOVERNMENT/municipality of the city, town or village where an applicant was born. Please note, school certificates, baptismal certificates, or certificates from hospital where an applicant was born are not sufficient. The birth certificate must be issued by the local government.
If the local government has no record of the birth, then a Certificate of Non-Availability must be obtained. A Certificate of Non-Availability is a statement from the local government/municipality stating that there is no record of the birth. In addition to the Certificate of Non-Availability, two Affidavits of Birth from persons with knowledge of the birth; parents, relatives or friends who were adults when the applicant was born must be submitted. NOTE: Applicant's parents may submit the affidavits. An Affidavit is a statement under oath and need NOT be notarized provided the Affidavit contains a signed self-attestation clause.
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INSTRUCTIONS FOR FILLING OUT THE AFFIDAVIT
FILL OUT THE INFORMATION (TYPE OR WRITE IN CAPITAL LETTERS)
HAVE THE PERSON PROVIDING THE AFFIDAVIT SIGN AND DATE IN THE PLACES PROVIDED.
IT IS NOT REQUIRED TO TAKE THIS AFFIDAVIT FOR NOTARIZATION. THIS AFFIDAVIT CONTAINS A SIGNED "SELF ATTESTATION" CLAUSE.
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EXAMPLE OF A FILLED AFFIDAVIT OF BIRTH BY AN UNCLE
I, John S. Smith (Print Full Name), do hereby solemnly state and affirm as follows:
I was born on 12 January 1940 (Date), at London, England (City and Country of Birth).
I have known Mary Adams (maiden name Mary Smith) since the day she/he was born, because I am her father's brother. (state exact relationship).
I personally know that Mary Adams was born on 15 February 1960 (Date of birth), at Washington, D.C., U.S.A. (City and Country of Birth) because I was informed by my brother, Mary's Father, Mr. Thoms H. Smith, that he had been blessed with a daughter (State How You Know of the Birth) The full names of Mary's parents are:
My current address is:
12 Utopia Place
London, England
Phone:
Date: August 22, 1999 (Signature)
(Print Name) John S. Smith
I hereby declare under penalty of perjury pursuant to the laws of the United States of America (28 U.S.C. § 1746) that the foregoing is true and correct.
Executed on August 22, 1999 (Date) at London, England (City and Country where this Affidavit is Signed).
(Signature)
(Print Name) John S. Smith
AFFIDAVIT OF BIRTH
I, (Print Full Name), do hereby solemnly state and affirm as follows:
I was born on (Date), at (City and Country of Birth).
I have known since the day she/he was born, because I am (state exact relationship).
I personally know that was born on (Date of birth), at (City and Country of Birth) because (State How You Know of the Birth) The full names of parents are:
My current address is:
* (insert current address)
Date: (Signature)
(Print Name)
I hereby declare under penalty of perjury pursuant to the laws of the United States of America (28 U.S.C. § 1746) that the foregoing is true and correct.
Executed on (Date) at (City and Country where this Affidavit is Signed).
(Signature)
(Print Name)
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END SAMPLE AFFIDAVIT OF BIRTH
