STATE OF VERMONT SUPERIOR COURT PROBATE ......700-00200AC – Affidavit in Support of Petition for...
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700-00200AC – Affidavit in Support of Petition for Corrected Birth Certificate (03/2018) Page 1 of 1 STATE OF VERMONT SUPERIOR COURT PROBATE DIVISION Unit Docket No. In re: AFFIDAVIT IN SUPPORT OF PETITION FOR CORRECTED BIRTH CERTIFICATE In support of the petition for a corrected Birth Certificate, I state under oath, I qualify under one of the following categories: ☐ Self ☐ Parent or Guardian ☐ The hospital in which the birth occurred ☐ The certifying attendant, or custodian ☐ I have the following personal knowledge to support my Petition for a corrected Birth Certificate: Date Signature of Petitioner Printed Name Signed and sworn to before me: Date Signature of Notary Public Expiration Date Name on Certificate
Transcript of STATE OF VERMONT SUPERIOR COURT PROBATE ......700-00200AC – Affidavit in Support of Petition for...
700-00200AC – Affidavit in Support of Petition for Corrected Birth Certificate (03/2018) Page 1 of 1
STATE OF VERMONT
SUPERIOR COURT PROBATE DIVISION
Unit Docket No.
In re:
AFFIDAVIT IN SUPPORT OF PETITION FOR CORRECTED BIRTH CERTIFICATE
In support of the petition for a corrected Birth Certificate, I state under oath, I qualify under one of the following categories: ☐ Self ☐ Parent or Guardian ☐ The hospital in which the birth occurred ☐ The certifying attendant, or custodian
☐ I have the following personal knowledge to support my Petition for a corrected Birth Certificate:
Date Signature of Petitioner
Printed Name
Signed and sworn to before me:
Date Signature of Notary Public Expiration Date
Name on Certificate
