Transcript
SAMPLE AFFIDAVIT Affidavit of Birth of ____________________________________________________________________________________________. [first, middle and LAST name of I-485 applicant] I, ____________________________________________________________________________________, certify: [first, middle and LAST name of person writing affidavit]
I am _______________________________________________’s ___________________________________________________________. [name of I-485 applicant] [description of relationship to I-485 applicant, i.e. biological mother, father, aunt, uncle, older sibling]
I was born on _______________________________________in ___________________________________________________________. [month, date and year of birth] [town or province and country of birth]
I married _______________________________________________ on __________________ in _____________________________________. [full name of spouse] [date of marriage] [place of marriage].
My spouse _____________________________________________ was born on __________________ in _______________________________. [full name of spouse] [date of birth] [place of birth]
My spouse ____________________________________________ and I had a child named________________________________________________. [name of spouse] [first, middle and LAST name of I-485 applicant] * NOTE: If affidavits are being signed by someone other than the I-485 applicant’s parents, the affidavit must still list the full names of both of the I-485 applicant’s parents.
_______________________________________________________ was born on _________________________ in __________________________. [name of I-485 applicant] [month, date and year of birth] [town or province and country of birth]
___________________________________________ _____________was born at __________________________________________________. [name of I-485 applicant] [place of birth, i.e. name of hospital, home] located in __________________________________ at __________________ on ____________________________. [town or province and country] [time of birth] [date of birth]
I know that ________________________________________________ was born on this date because ____________________________________ [name of I-485 applicant] _______________________________________________________________________________________. [explanation of how person writing affidavit knows of the birth of the I-485 applicant]
I currently reside at ______________________________________________________________________________________________________. [address of person writing the affidavit].
I declare under penalty of perjury that the above is a true and correct statement. ______________________________________ [name of person writing the affidavit]
______________________________________ [signature of affiant]
Subscribed and sworn to before me on ________________________ in ____________________________________________________. [date notary signs this document] [city and country where notary executed the affidavit]
_________________________________________ Notary [signature of notary]
Notary stamp
