Sample Affidavit of Birth


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]

Mother’s Signature

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


Nevada attorney directory. Law firms in State of Nevada. 



About Gary Goodin

Gary Goodin is a Las Vegas immigration lawyer providing legal services in US green card and citizenship cases. His law firm offers services for marriage green cards, k1 visas, naturalization, and citizenship. Attorney Goodin is a proud member of The Florida Bar and the American Immigration Lawyers Association (Nevada and Central Florida chapters).

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