Free Kentucky Affidavit of Birth Template
Kentucky Affidavit of Birth
State of Kentucky
County of [COUNTY]
Introduction:
I, [YOUR NAME], being duly sworn, depose and say:
Statement of Facts:
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The undersigned affiant, [YOUR NAME], residing at [YOUR ADDRESS] and reachable at [YOUR TELEPHONE NUMBER], hereby affirms their relationship to the registrant as the mother, providing valid identification and supporting documentation as required by the relevant authorities.
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This affirmation is made in accordance with legal requirements to obtain the birth record of the registrant.
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The subject of this affidavit, [Full Name of the Person at Birth], was born on [Month], [Day], [Year], in [City/County, State, Hospital].
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At the time of the registrant's birth, the parent(s) were listed as [Full Name(s) of Parent(s) at the Time of Birth].
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This statement is made to assert the accuracy of the birth record in question and to verify my relationship and proximity to the events described.
Circumstance of Affidavit:
This affidavit is made in support of obtaining a replacement for the lost birth certificate of the above-named registrant. I hereby affirm that the original birth certificate for the registrant has been lost, and no other form of official birth record for the registrant is available to me/us.
Affirmation of Truth:
I affirm that the information provided in this affidavit is true and correct to the best of my knowledge and belief. I understand that providing false statements in this affidavit is subject to penalties for perjury.
Reason for Replacement Request:
Describe the reason for the lost birth certificate and any efforts made to locate the original document. Include details, if applicable, about why the replacement is necessary (e.g., for obtaining a passport, driver's license).
Signature and Notarization:
IN WITNESS WHEREOF, I have hereunto set my hand this [DAY], of [MONTH], [YEAR].
[YOUR NAME]
Subscribed and sworn to before me this [DAY], of [MONTH], [YEAR] , by [YOUR NAME], who is personally known to me or has produced government-issued identification, such as a driver's license or passport, as identification.
[Notary Public's Signature]
