Affidavit to Correct a Birth Certificate - Free Download
4.1, 3672 votes
Please vote for this template if it helps you.
Affidavit to Correct a Birth Certificate
Affidavit to Correct a Birth Certificate
AFFIDAVIT TO CORRECT A BIRTH CERTIFICATE
STATE OF ____________________________________ COUNTY ____________________________
***************************************************************************************
INFORMATION AS IT APPEARS ON THE ORIGINAL BIRTH CERTIFICATE
Name as Recorded __________________________________________________________________
Date of Birth _____________________________________________________________________
Place of Birth ___________________________________________________________________
Father's Name _____________________________________________________________________
Mother's Maiden Name _________________________________________________________________________
***************************************************************************************
ITEMS TO BE CORRECTED OR ADDED
_________________________________ Should Read _________________________________
_________________________________ Should Read _________________________________
_________________________________ Should Read _________________________________
_________________________________ Should Read _________________________________
_________________________________ Should Read _________________________________
***************************************************************************************
FOLLOWING AFFIDAVIT IS TO BE COMPLETED BY THE PERSON WHOSE BIRTH CERTIFICATE IS TO BE
CORRECTED:
I _______________________________________________________ , born _______________________________
(Date of Birth)
and residing at __________________________________________________________________________________
being first duly sworn, say that to the best of my knowledge the foregoing facts are true and correct.
Signature ___________________________________________________________________
Date Signed __________________________________________________________________
SIGNATURE OF NOTARY PUBLIC ______________________________________________
Commission Expires ___________________________________________________________
Notary Seal Submit To:
CUSTOMER SERVICE
VITAL REGISTRATION
ROOM 165
350 CAPITOL STREET
CHARLESTON, WV
25301-
3701
Affidavit to Correct a Birth Certificate Previous Page Affidavit to Correct a Birth Certificate Next Page
Affidavit to Correct a Birth Certificate
Previous

1/2

Next