I , residing at , , , , certify under penalty of perjury that I was born on at and as follows:
This affidavit is executed on behalf of the following person:
Name: Gender: Age:
Citizen of: Marital Status: Relationship to Sponsor:
Current Address: City: State: Country:
Name Before Marriage:
I further declare, was born on in , , to and ,
I have direct personal knowledge of the event and circumstances concerning the birth of because , and
I have known the applicant since ,
This affidavit is being submitted because .
Oath or Affirmation of Affiant:
I certify under penalty of perjury under law that I know the contents of this affidavit signed by me and that the statements are true and correct.
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