Birth Certificate Unavailability Statutory Declaration Form
Complete the Birth Certificate Unavailability Statutory Declaration Form to formally declare that a birth certificate cannot be provided.
Full Name of Declarant
*
First Name
Last Name
Date of Birth of Declarant
*
-
Month
-
Day
Year
Date
Place of Birth of Declarant (City, State/Province, Country)
*
Declarant's Relationship to Person Named on Certificate
*
Please Select
Self
Parent
Legal Guardian
Other
Full Name of Person Named on Certificate (if not self)
Reason Birth Certificate is Unavailable
*
Supporting Explanation or Additional Information
Declarant's Email Address
*
example@example.com
Declarant's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Signature of Declarant
*
Submit Declaration
Submit Declaration
Should be Empty: