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Affidavit of Birth

Affidavit of Birth

State of [State]

County of [County]

I, [Affiant’s Name], residing at [Address], [City], [State] [ZIP Code], social tax number [Tax ID], being duly sworn, testify and state as follows:

Reason for Affidavit. This Affidavit is being submitted because [Reason].

I further declare that [Applicant’s Name], [Applicant Gender], residing at [Address], [City], [State] [ZIP Code], social tax number [Tax ID](the "Applicant"), was born on [Date of Birth], in the city of [Birth City], [Birth County] County, State of [Birth State].

I have known the Applicant since [Date], and I possess knowledge of the Applicant’s birth details because [Proof of Awareness].

The Applicant’s parents are:

  • Father: [Father’s Name]
  • Mother: [Mother’s Name]

Legal acknowledgment. I declare under penalty of perjury that the above information I gave is true and correct to the best of my knowledge. I understand that any false statements may have legal consequences.

This Affidavit was made on [Signing Date].

____________________________

[Affiant’s Name]

(Affiant’s Signature)

Official Acknowledgment

Identifying document presented. The following document was provided by the Affiant for verification:

[Id Document Type]

  • ID number: [ID Number]
  • Issuing authority: [Place of Issue]
  • Issue date: [Issue Date]
  • Expiration date: [Expiration Date]

On [Signing Date], the Affiant listed above, who is not related to me, personally appeared before me and is known to me to be the person whose name is subscribed to and acknowledged that the Affiant executed the same for the uses and purposes therein contained. I have appropriately verified the identity of the Affiant by personally viewing the aforementioned identification document and matching photocopy.

State of [State]

Acting in the county of [County]

___________________________________

([Certifier Type]’s Signature)

______________________________________

[Certifier Type]’s Full Legal Name

Party 1

________________

Signature

Date: ________________

Party 2

________________

Signature

Date: ________________

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What Is a Affidavit of Birth?

An Affidavit of Birth in the United States confirms specified facts through a signed declaration sworn before a commissioner for oaths or notary.

Affidavits of birth derive their legal authority from state evidence codes and administrative regulations. Under 18 U.S.C. 1621, making a false statement in a sworn affidavit constitutes perjury, a federal crime punishable by up to five years' imprisonment. This criminal penalty gives affidavits significant evidentiary weight, as courts presume that individuals making sworn statements understand the consequences of falsification.

The U.S. Department of State accepts affidavits of birth as secondary evidence for passport applications under 22 CFR 51.42 when a birth certificate is unavailable. USCIS (U.S. Citizenship and Immigration Services) accepts them in immigration proceedings when primary documents cannot be obtained. Many state vital records offices also accept affidavits of birth as supporting documentation when applying for a delayed birth certificate registration -- particularly for individuals born at home, in rural areas, or before modern birth registration systems were established.

When Do You Need a Affidavit of Birth?

An Affidavit of Birth is most commonly needed when applying for a U.S. passport and the applicant cannot obtain a certified birth certificate. The State Department requires the affidavit to be from someone with personal knowledge of the birth, typically a parent, relative, or attending midwife, and it must be accompanied by a letter from the vital records office confirming that no birth record exists.

Immigration proceedings frequently require an Affidavit of Birth when applicants from countries with incomplete vital records systems cannot produce an official birth certificate. USCIS Form I-485 (Adjustment of Status) and consular processing applications accept this affidavit as secondary evidence.

Individuals born at home without medical attendance -- which was common in rural areas before the mid-20th century -- often need this affidavit to establish their birth for Social Security benefits, Medicare enrollment, or veteran's benefits applications. School enrollment for children whose birth certificates are delayed or lost may also require a birth affidavit.

Correcting errors on an existing birth certificate, such as misspelled names or incorrect dates, often requires a supporting affidavit from someone who can attest to the correct information. Without this documentation, individuals face significant barriers to obtaining identity documents, government benefits, and legal recognition of their birth facts.

What to Include in Your Affidavit of Birth

The affiant's full legal name, address, date of birth, and relationship to the individual whose birth is being attested must be clearly stated. The affiant must have personal knowledge of the birth -- secondhand information or hearsay is not sufficient for a legally valid birth affidavit. Courts and government agencies will scrutinize whether the affiant was actually present at the birth or has direct knowledge of the circumstances.

The child's full name at birth, exact date of birth (month, day, year), time of birth (if known), and precise place of birth (city, county, state, and hospital name if applicable) are essential facts. The more specific the information, the more weight the affidavit carries with reviewing agencies. If the birth occurred at a private residence, the street address should be included.

The full legal names of both parents, including the mother's maiden name, must be included. This information is necessary for establishing parentage and is cross-referenced by vital records offices when processing delayed birth registration applications.

A sworn statement (jurat) confirming that the affiant is making the declaration under penalty of perjury under the laws of the applicable state is required. The specific language of the jurat may vary by state. The affidavit must be signed by the affiant in the presence of a notary public, who verifies the affiant's identity through government-issued identification and administers the oath.

The notary's signature, seal, and commission expiration date must appear on the document. Some government agencies, including the U.S. Department of State, require the affidavit to have been executed within a specific timeframe (typically within the past year) to be accepted as current evidence.

Sources & Citations

Statutory citations link to official government sources.

  1. 18 U.S.C. 1621US – Cornell LII
  2. 22 CFR 51.42US – eCFR

Cite this page

Reference this free template in an article, syllabus, or research note:

APA

Forms Legal. (2026). Affidavit of Birth (United States) [Legal document template]. Forms Legal. https://forms-legal.com/usa/government/declarations/affidavit-birth

MLA

"Affidavit of Birth (United States)." Forms Legal, 2026, https://forms-legal.com/usa/government/declarations/affidavit-birth.

BibTeX
@misc{formslegal-affidavit-birth,
  author       = {{Forms Legal}},
  title        = {Affidavit of Birth (United States)},
  year         = {2026},
  howpublished = {\url{https://forms-legal.com/usa/government/declarations/affidavit-birth}},
  note         = {Free legal document template. Based on 28 U.S.C. §1746}
}

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Frequently Asked Questions

Based on 28 U.S.C. §1746 — Template last modified June 2026Verify the source →

This template is provided for informational purposes only and does not constitute legal advice. Laws vary by jurisdiction and change over time. Consult a qualified attorney for advice specific to your situation.Full disclaimer

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