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To all Men know these presents that the second born Daughter called
Childs First-Middle
was delivered live in the flesh and blood unto Fathers First-Middle and his wife Mothers First-
Middle during the first, second of their marriage up on the land area known as CountyName
County State (state) Republic.
_______________________County )
) ss.
_______________________ (State) Republic )
By Special Appearance, before me, a Notary public, Fathers First-Middle and Mother First-Middle, both
of the Family family, affirms that they are the Natural Persons / Divine Beings herein named, meeting
the law of evidence as required and defined in Identity; affirmed by Lawful, Substantive Right; by
Birthright; and respectively acknowledged being lawfully qualified and competent to execute this
document.
I therefore place my hand and seal thereto done this _______ day of _________________ in the year 20___.