Birth Certificate Template

Birth Certificate Template
Date Today
MonthDayYear
Date
Name of Child
First NameMiddle NameLast NameSuffix
Sex
Date of Birth
MonthDayYear
Place of Birth
Name of Place/Hospital/Clinic/House Number
Street Address
CityState / Province
Postal / Zip Code
Type of Birth
Single, Twin, Triplet, etc.
If multiple birth, child was
second, third, fourth, etc.
Birth Order
Order of birth to previous child births (first, second, etc.)
Body Weight
Mother
Mother's Maiden Name
First NameMiddle NameLast Name
Nationality
Religion
Date of Birth
MonthDayYear
Date
Age
Total number of children born alive
Number of children alive today
Include this current child birth
Number of children born alive but are now dead
Residence
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Father
Father's Name
First NameMiddle NameLast Name
Nationality
Religion
Date of Birth
MonthDayYear
Date
Age
Residence
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Marriage Information
Date of Marriage
MonthDayYear
Date
Place of marriage
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
If not married, please check the box below
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
{mothersMaiden}

Signature of Mother
{name12}

SUBSCRIBED AND SWORN to before me on this  day of    , in the year   Year   , by {mothersMaiden} and {name12} who exhibited to me their proof of identity with identification number   ID Number   /   ID Number, issued onDate of Issue  /   Date of Issue, at   Place of Issue /    Place of Issue    .

Signature
First Name   Last Name
Title/Position
Should be Empty:

Birth Certificate Template

Mother

Father

Marriage Information