Application For Registration Of Birth {624.00}

Case # David E. Woessner American LegalNet, Inc. www.FormsWorkFlow.com Supporting Affidavits IN THE MATTER OF THE REGISTRATION OF BIRTH- AFFIDAVIT OF PHYSICIAN STATE OF OHIO, ________________________________________________ The undersigned, being first duly sworn, deposes and says that he/she was the physician in attendance at the birth of ________________________________________, the applicant. He/she has read the application and believes the facts (Name of applicant at birth) stated herein are true. ________________________________________________________ Attending physician ___________________________________________________________________________ Address Sworn to before me and signed in my presence by the said _______________________________________ this ________ day of _____________________, 20___. _____________________________________________ ___________________________________________________________________________ Official Title NOTE: If the affidavit of the attending physician cannot be secured, the application must be supported by the following affidavits of two persons having personal knowledge of the facts. STATE OF OHIO, ________________________________________________ Affidavit The undersigned, being first duly sworn, deposes and says that __he is ______ years of age, that __he has read the application and that __he has personal knowledge of the facts stated therein by reason of being _________________ _________________________________________________________________________________________________ (State relationship, if any, or state facts showing personal knowledge) and that the statements made in the application are believed to be true. ________________________________________________________ Signature of Affiant ___________________________________________________________________________ Address Sworn to before me and signed in my presence by the said _______________________________________ this _________ day of _____________________, 20____. ________________________________________________________ ________________________________________________________ Official Title STATE OF OHIO, ________________________________________________ Affidavit The undersigned, being first duly sworn, deposes and says that __he is ______ years of age, that __he has read the application and that __he has personal knowledge of the facts stated therein by reason of being _________________ _________________________________________________________________________________________________ (State relationship, if any, or state facts showing personal knowledge) and that the statements made in the application are believed to be true. ___________________________________________________________________________ Signature of Affiant ___________________________________________________________________________ Address Sworn to before me and signed in my presence by the said _______________________________________ this _________ day of _____________________, 20____. __________________________________________________________________________ __________________________________________________________________________ Official Title American LegalNet, Inc. www.FormsWorkFlow.com