AFFIDAVIT BY [Father's First Name] [Father's Last Name] and [Mother's First Name] [Mother's Last Name] (Mothers Maiden Name: Mother's Maiden Name)

Re: [Child's First Name] [Child's Last Name] (If child is married, list the following: (Child's Maiden Name: Child's Maiden Name))

We,  [Father's First Name] [Father's Last Name] and [Mother's First Name] [Mother's Last Name], hereby depose and say:

1. Our full and complete address is [street address with apartment or house number, town/city, state, postal zip code].
2. That I, [Father's First Name] [Father's Last Name] was born on [date] in the town/city of [city], [country].
3. That I, [Mother's First Name] [Mother's Last Name] (Mother's Maiden Name: Mother's Maiden Name), was born on [date] in the town/city of [name of city], [country].
4. We married on [date of marriage] in the city of [name of city], [country].
5. We [Father's First Name] [Father's Last Name] and [Mother's First Name] [Mother's Last Name] had the following children:

   a. [Child’s First Name] [Child's Last Name] (If child is married list the following: (Child's Maiden Name: Child's Maiden Name) born on [date]; and

   b. [list all of the other children, if applicable].

6. [Child's First Name] [Child's Last Name] was born in [name of city], [country].

7. This affidavit is being submitted because [CHOOSE ONE] there is no official record of birth [OR} the official record of birth is incomplete concerning [Child's First Name] [Child's Last Name].

We declare under penalty of perjury, that the foregoing is a true and correct statement.

_________________________
[Father's First Name] [Father's Last Name] and signature

_________________________
[Mother's First Name] [Mother's Last Name] and signature 

 

Subscribed and Sworn to before
Me, this ____ day of __________,
[YEAR] at ______________________.