"Affidavit for Correction of a Vital Record" - Montana

Affidavit for Correction of a Vital Record is a legal document that was released by the Montana Department of Public Health and Human Services - a government authority operating within Montana.

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Download "Affidavit for Correction of a Vital Record" - Montana

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Montana Department of Public Health &Human Services
Office of Vital Records
(PO Box 4210, Helena, MT 59604)
AFFIDAVIT
For Correction of a Vital Record
I hereby swear that the record of BIRTH/DEATH for____________________________________________
(Current Name on Record)
who was born/died in the city of _____________________ County of __________________________
on ________________________ is incorrect or incomplete as follows:
(Current date on record)
The record now shows:
The true facts are:
________________________________________
______________________________________
_________________________________________
_______________________________________
_________________________________________
_______________________________________
_________________________________________
_______________________________________
_________________________________________
_______________________________________
I have the consent of all parties concerned in stating these true facts. I further declare that if the corrected
certificate is questioned, I will assume the responsibility of furnishing proof of the corrected item to the
questioning agency. It is recommended to retain copies of all supporting documents.
The probative value of an ltered certificate of birth is determined by the judicial or administrative body before whom the certificate is offered as
evidence. 50-15-204(5) M.C.A.
I further swear that I represent the individual as: Self
Parent Attorney
Other
(Check one)
(Specify)
Signed ______________________________________
Address ______________________________________
_____________________________________
Phone number______________________________________
Verification of Signer’s ID Is Mandatory
State of ________________________
County of ______________________
This record was signed and sworn to (or affirmed) before me on ___________________ by
(Date)
_____________________________
(Name of Applicant)
______________________________
(Notary’s Signature)
[Official Stamp]
Print Form
Clear Form
Montana Department of Public Health &Human Services
Office of Vital Records
(PO Box 4210, Helena, MT 59604)
AFFIDAVIT
For Correction of a Vital Record
I hereby swear that the record of BIRTH/DEATH for____________________________________________
(Current Name on Record)
who was born/died in the city of _____________________ County of __________________________
on ________________________ is incorrect or incomplete as follows:
(Current date on record)
The record now shows:
The true facts are:
________________________________________
______________________________________
_________________________________________
_______________________________________
_________________________________________
_______________________________________
_________________________________________
_______________________________________
_________________________________________
_______________________________________
I have the consent of all parties concerned in stating these true facts. I further declare that if the corrected
certificate is questioned, I will assume the responsibility of furnishing proof of the corrected item to the
questioning agency. It is recommended to retain copies of all supporting documents.
The probative value of an ltered certificate of birth is determined by the judicial or administrative body before whom the certificate is offered as
evidence. 50-15-204(5) M.C.A.
I further swear that I represent the individual as: Self
Parent Attorney
Other
(Check one)
(Specify)
Signed ______________________________________
Address ______________________________________
_____________________________________
Phone number______________________________________
Verification of Signer’s ID Is Mandatory
State of ________________________
County of ______________________
This record was signed and sworn to (or affirmed) before me on ___________________ by
(Date)
_____________________________
(Name of Applicant)
______________________________
(Notary’s Signature)
[Official Stamp]
Print Form
Clear Form