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AFFIDAVITOFOWNERSHIP

Stateof_____________}
}SS
Countyof____________}

RE:BirthCertificate

I,theundersigned,oflawfulageandbeingfirstdulysworn
onoath,
deposeandstatethatIamfamiliarwiththefactsrecited,
andthe
partynamedinsaidbirthcertificateisthesamepartyas
oneofthe
ownersnamedinsaidcertificateoftitle.

__________________________________
Signature

Signedandsworntobeforemethis________dayof
_____________________,20_____.
________________________________
________________________________
Notary
Public
My
CommissionExpires

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