INABILITY TO PROVIDE CERTIFIED BIRTH CERTIFICATE by few71840

VIEWS: 8 PAGES: 1

									                                                                                                    5111 F1



                       INABILITY TO PROVIDE CERTIFIED BIRTH CERTIFICATE



I, ________________________________________, hereby declare that I am unable to provide to the

schools, within the required time, a certified birth certificate for the child named below, for the following

reason(s):



__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________


In lieu of the required certified birth certificate, I am providing the following:

_____                noncertified birth certificate

_____                baptismal record

_____                court record

_____                doctor or hospital record

_____                passport

_____                immunization record

_____                other (specify) _______________________________________________




__________________________________                    ________________________________
Name of Child                                         Signature of parent/legal guardian

								
To top