I [your mother’s full name], being duly sworn, hereby affirm and state under oath that:
1. I live at [your mother’s complete address]
2. I was born in [your mother’s birth city/town, state/province and country] on [your mother’s birth date], and I am the mother of [your full name].
3. I am married to [your father’s complete name]. We have been married since [marriage date].
4. [Your full name] was born on [your birth date], to me and my spouse, [your father’s name]. [your full name] was born in [your birth city/town, state/province and country].
5. I gave birth to [your full name] and I am giving this sworn statement because no birth certificate/record exists for my [daughter/son] following numerous unsuccessful attempts by my husband and me at locating a birth certificate for our child.
6. I solemnly swear (affirm) that the above statement is true and correct to the best of my knowledge and belief.
[Print your mother’s full name] [Date]
Subscribed and Sworn to (affirmed) before me this day of , 20
Identifying Document Submitted (Type of Document, Date of Issuance/Expiration, Document Number)
Signature of Notary Place (City & State)
The contents of the affidavit will depend upon the facts of the case. This sample affidavit of birth is just a general guide. Giving false testimony under oath in connection with an immigration application is a federal criminal offense that can attract severe terms of imprisonment (18 U.S.C. § 154). For legal advice in a specific case consult a competent immigration attorney.
If you have any questions about the right evidence to prove eligibility for an immigration benefit feel free to contact me at 702-423-2721 or via the Contact Us form for a free and confidential immigration consultation. I also urge you to subscribe the RSS feed so you can see when I post new immigration articles.
Gary Goodin, Las Vegas, Nevada Immigration Attorney