Correction Of Birth Record Application Finding And Order For Correction Of Birth Record {2.0}

CORRECTION OF BIRTH RECORD Application, Finding and Order for Correction of Birth Record Case Number_ _ _ _ _ _ _ __ In the Probate Court of _ _ _ _ _ _ _ _ _ _ _County on the _ _ _ _ _day of _ _ _ _ _ _ _ _ __ J 20___, appeared _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ praying that his/her birth record be corrected in accordance with Section 3705.15 of the revised code as followed: Information recorded in this box should match information currently listed on the Birth Record. Child's Information Full Name of Child Date of Birth Place of Birth (city and county) Information of Parent(s) currently listed on the Birth Record Parent's Name Place of Birth Parent's Name I Date of Birth Place of Birth I Date of Birth ITEMS TO BE CORRECTED OR ADDED ITEM _ _ _ _ _ _ _ READS AS _ _ _ _ _ _ _ _ _ _ _ _ _SHOULD READ _ _ _ _ _ _ _ _ _ _ _ __ ITEM ITEM ITEM READS AS READS AS READS AS SHOULD READ _ _ _ _ _ _ _ _ _ _ __ SHOULD READ _ _ _ _ _ _ _ _ _ _ __ SHOULD READ_ _ _ _ _ _ _ _ _ _ __ The undersigned being first duly sworn, says the facts stated in the foregoing Application are true as he/she verily believes and prays that the Court order the registration of birth. Registrant of Applicant Address Sworn to before me and signed in my presence by the applicant or registrant aforesaid this. _ _ _ _day of_ _ _ _ _ _.20_. (SEAL) Official Character Journal Entry The court on consideration of the aforesaid evidence submitted finds and orders that notice of hearing be dispensed with and the birth record of registrant be corrected in accordance with the facts hereinabove set forth: and that a certified copy of the order of the Court be forthwith transmitted to the Director of Health, at Columbus, Ohio as provided by law. Probate Judge I hereby certify the above is a true copy of the application and entry in the foregoing matter. (SEAL) By_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Magistrate, Judge or Deputy Clerk HEA 2783 (REV. 8/2015) American LegalNet, Inc. www.FormsWorkFlow.com Supporting Affidavits In the Matter of the Correction of Birth Record of State of Ohio, _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Affidavit of Physician The undersigned, being first duly sworn, deposes and says the he was the physician in attendance at the birth of __________________ the applicant and that the facts stated herein are true as he/she verily believes. (Name of Applicant at Birth) (Attending Physician) (Address) Sworn to before me and signed in my presence by the s a i d - - - - - - - - - - - - - - - - - - - - - - - - - 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 affidavit, relative or non-relative, having persona! knowledge of the facts . .................................................................................·........·.............................. State of Ohio, _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Affidavit The undersigned, being first duly sworn, deposes and says that he/she is __ years of age, that he/she has read the application and that he/she has personal knowledge of the facts stated therein by reason of b e i n g - - - - - - - - - - - - - - - - (state relationship, If any, or state facts showing personal knowledge} and that the statements made in the application are true as he/she verily believes. (Signature of Affiant) (Address) Sworn to before me and signed in my presence by the s a i d - - - - - - - - - - - - - - - - - - - - - - - - - this day of , 20_. (Official Title) ............................................·............·......................................................···...... State of Ohio, _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Affidavit The undersigned, being first duly sworn, deposes and says that he/she is __ years of age, that he/she has read the application and that he/she 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 true as he/she verily believes. (Signature of Affiant) (Address) Sworn to before me and signed in my presence by the s a i d - - - - - - - - - - - - - - - - - - - - - - - - - this day of , 20_. (Official Title) HEA 2783 (REV. 8/2015) American LegalNet, Inc. www.FormsWorkFlow.com