Birth Certificate Template

 Name:
{name}
 Sex:  Type of Birth:  Body Weight:
{typeA} {typeA6} {typeA10}
 If Multiple Births, Child Was:  Birth Order:  Date of Birth:
{typeA8} {typeA9} {typeA5}
 Place of Birth:
{address:addr_line1} {address:addr_line2} {address:city} {address:state} {address:postal}

Mother
 Mother's Maiden Name:  Age:
{name12} {typeA21}
 Religion:  Nationality:  Date of Birth:
{typeA14} {typeA13} {date}
Number of Children Born Alive But Are Now
Number of Children Born Alive:   Number of Children Alive Today:
Dead:
{number} {totalNumber}
{number18}
 Resident Address:
{address20:addr_line1} {address20:addr_line2} {address20:city} {address20:state} {address20:postal}

Father
 Father's Name:  Age:
{mothersMaiden} {age}
 Religion:  Nationality:  Date of Birth:
{religion} {nationality} {dateOf}
     
 Resident Address:
{address20:addr_line1} {address20:addr_line2} {address20:city} {address20:state} {address20:postal}

Marriage Information

Not married

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 AFFIDAVIT OF ACKNOWLEDGMENT/ADMISSION OF PATERNITY

I/We {mothersMaiden} and {name12}, of legal age, are the natural parents of {name}, who was
born on {typeA5}, at {address:addr_line1} {address:addr_line2} {address:city} {address:state}.

I am/We are executing this affidavit to attest to the truthfulness of the foregoing statements and
for purposes of acknowledging my/our child.

Signature of Father   
Signature of Father
{mothersMaiden}

Signature of Mother      
Signature of Mother
{name12}

SUBSCRIBED AND SWORN to before me on this  day of    , in the year   2194   , by

Year
{mothersMaiden} and {name12} who exhibited to me their proof of identity with identification
number   219406    /   219406 , issued on11/13/2021   /   7/11/2020 , at   Petaluma, California
ID Number ID Number Date of Issue Date of Issue Place of Issue
 /    Petaluma, California    .
Place of Issue

Signature   
Signature
Kobe    Good    
First Name Last Name
Administrator   
Title/Position

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