Affidavit as to Identity by a Third Party
STATE OF ____________________
COUNTY OF _______________________
PERSONALLY appeared before me, the undersigned authority in and for said county
and state, (Name of Affiant), who, having been being first duty sworn by the
undersigned Notary Public, deposes and says:
1. Affiant is the (describe relationship) of that certain person identified in the
duplicate birth certificate attached hereto as Exhibit A, who is identified as (Name of
Person to be Identified) in said Birth Certificate.
2. Affiant positively knows that said (Name of Person to be Identified), whose
picture is attached hereto as Exhibit B, is the person identified in said Birth Certificate.