Birth Certificate Template

Name:
Jonathan Davidson Smith, Jr.

Sex:
Male

Type of Birth:
Twin

Body Weight:
[{"Lbs":"9.02","KGs":"4.1"}]

If Multiple Births, Child Was:
First

Birth Order:
First

Date of Birth:
August 3 2021

Place of Birth:
Saint Claire Hospital 219 Wilson Street Petaluma California 94952

Mother

Mother's Maiden Name:
Angela Lewis Davidson

Age:
32

Religion:
Catholic

Nationality:
American

Date of Birth:
Thursday, January 11, 1990

Number of Children Born Alive:
2

Number of Children Alive Today:
2

Number of Children Born Alive But Are Now Dead:
0

Resident Address:
2499 Davis Avenue Street Address: 2499 Davis Avenue
City: Petaluma
State / Province: California
Postal / Zip Code: 94952
Petaluma California 94952

Father

Father's Name:
Jonathan Andrews Smith

Age:
32

Religion:
Catholic

Nationality:
American

Date of Birth:
Wednesday, February 1, 1989

Resident Address:
2499 Davis Avenue Street Address: 2499 Davis Avenue
City: Petaluma
State / Province: California
Postal / Zip Code: 94952
Petaluma California 94952

Marriage Information

Not married

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AFFIDAVIT OF ACKNOWLEDGMENT/ADMISSION OF PATERNITY

I/We Jonathan Andrews Smith and Angela Lewis Davidson, of legal age, are the natural parents of Jonathan Davidson Smith, Jr., who was born on August 3 2021, at Saint Claire Hospital 219 Wilson Street Petaluma California.

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

Item - Signature of Father 1 Signature of Father
Jonathan Andrews Smith

Item - Signature of Mother 2 Signature of Mother
Angela Lewis Davidson

SUBSCRIBED AND SWORN to before me on this day of , in the year 2021Year , by Jonathan Andrews Smith and Angela Lewis Davidson who exhibited to me their proof of identity with identification number 3902390ID Number / 2342343ID Number, issued on11/13/2021Date of Issue / 7/11/2020Date of Issue, at Petaluma, CaliforniaPlace of Issue / Petaluma, CaliforniaPlace of Issue .

Item - Signature 3 Signature
KobeFirst Name GoodLast Name
AdministratorTitle/Position