Driver's License/Identification Card Birth Affidavit Form - Maine

This printable "Driver's License/Identification Card Birth Affidavit Form" is a document issued by the Maine Department of the Secretary of State specifically for Maine residents.

Download a PDF of the latest edition of the form down below or find it through the department's forms library.

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State of Maine
Secretary of State – Bureau of Motor Vehicles
DRIVER’S LICENSE/IDENTIFICATION CARD BIRTH AFFIDAVIT
See Reverse for Instructions
Section A – To be completed by the Driver’s License/Identification Card applicant
Name of Applicant Whose Birth is to be proved
Sex
Last
Title (Jr., Sr., III)
Male
First
Middle
Female
Applicant’s Date of Birth (mm-dd-yyyy)
Applicant’s Place of Birth
Name of Applicant’s Parents
Father
Mother
Applicant’s Current Address
Street
Apartment Number
City
State
ZIP Code
Section B – To be completed by person that has knowledge of applicant’s birth.
Number of Years You Have Known the Applicant: ___________________________________
State all the facts you know about the applicant’s birth, including your relationship to the applicant. State how you
obtained the knowledge. Please use additional sheet(s) of paper if more space is required.
_______________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
My name is ______________________________________________. My birth date is __________________.
(Your full legal name)
(Month/day/year)
I presently reside at ___________________________________________ in ___________________________.
(Street Address)
(City and State)
My phone numbers where I can be reached are: Home:_____________________; cell:___________________;
work:____________________. I am usually at work from _____________ a.m./p.m. to ___________a.m./p.m.
My mailing address is :
same as above or:
_________________________________________________________________________________________.
(check the box if same as above, or insert complete mailing address if different from your street address)
Subscribed and sworn to under pains and penalties of perjury.*
Signature: ____________________________________________________ Date: ______________________
*By signing this statement, I verify that the representations herein are true. By making false statements on
this document, I realize I am committing a Class D crime punishable under Maine law.
Maine Bureau of Motor Vehicles staff may contact you, the Affiant, to verify the information provided.
Section A Instructions – to be completed by the driver’s license/ID card applicant.
101 Hospital Street 29 State House Station
Augusta, Maine 04333
207-624-9000 ext. 52114 TTY Users Call Maine Relay 711
State of Maine
Secretary of State – Bureau of Motor Vehicles
DRIVER’S LICENSE/IDENTIFICATION CARD BIRTH AFFIDAVIT
See Reverse for Instructions
Section A – To be completed by the Driver’s License/Identification Card applicant
Name of Applicant Whose Birth is to be proved
Sex
Last
Title (Jr., Sr., III)
Male
First
Middle
Female
Applicant’s Date of Birth (mm-dd-yyyy)
Applicant’s Place of Birth
Name of Applicant’s Parents
Father
Mother
Applicant’s Current Address
Street
Apartment Number
City
State
ZIP Code
Section B – To be completed by person that has knowledge of applicant’s birth.
Number of Years You Have Known the Applicant: ___________________________________
State all the facts you know about the applicant’s birth, including your relationship to the applicant. State how you
obtained the knowledge. Please use additional sheet(s) of paper if more space is required.
_______________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
My name is ______________________________________________. My birth date is __________________.
(Your full legal name)
(Month/day/year)
I presently reside at ___________________________________________ in ___________________________.
(Street Address)
(City and State)
My phone numbers where I can be reached are: Home:_____________________; cell:___________________;
work:____________________. I am usually at work from _____________ a.m./p.m. to ___________a.m./p.m.
My mailing address is :
same as above or:
_________________________________________________________________________________________.
(check the box if same as above, or insert complete mailing address if different from your street address)
Subscribed and sworn to under pains and penalties of perjury.*
Signature: ____________________________________________________ Date: ______________________
*By signing this statement, I verify that the representations herein are true. By making false statements on
this document, I realize I am committing a Class D crime punishable under Maine law.
Maine Bureau of Motor Vehicles staff may contact you, the Affiant, to verify the information provided.
Section A Instructions – to be completed by the driver’s license/ID card applicant.
101 Hospital Street 29 State House Station
Augusta, Maine 04333
207-624-9000 ext. 52114 TTY Users Call Maine Relay 711
Maine law requires a person to be lawfully present in the United States to be eligible to receive a
driver’s license or identification card. A United States citizen, born in the United States or abroad,
may submit a birth affidavit when an acceptable birth document cannot be obtained. Before you
may use this form, you must obtain an official letter from the state in which you were born
advising that no birth record exists. This letter must include your name, date of birth, the years
covered by the search for the birth record and that no birth records exist. If you were born in another
country, you must obtain an official letter or statement from a representative of the country advising
the birth record is unavailable before you may use this form.
HOW TO USE THIS AFFIDAVIT FORM
1. Complete the information on the top of the form that applies to you.
2. Give this form to a person who has knowledge of your birth and/or your relationship to your
parents.
3. You must have two separate affidavits completed by two different individuals.
4. Make sure the person who filled out the form did so completely.
5. Attach the official letter from the state in which you were born advising that no birth record
exists.
6. Return to the Bureau of Motor Vehicles office with the two (2) affidavits to apply for your
Maine driver’s license or identification card.
Section B Instructions – to be completed by the person that has knowledge of applicant’s
birth.
The individual providing you this form is applying for a Maine driver’s license and/or ID card and
needs your help to show that s/he is a United States citizen. The Bureau of Motor Vehicles allows
certain driver’s license/identification card applicants to prove that they are United States citizens
through sworn statements by individuals who have personal knowledge of the birth. The Bureau of
Motor Vehicles may contact you to verify the information you provide in the form. Knowingly
providing false information is a Class D crime.
HOW TO FILL OUT THE AFFIDAVIT FORM (see reverse side for the form)
1. Print, type or write legibly.
2. Sign and date the form.
3. You may want to make a copy of the completed form to keep for your records.
4. You must be 18 years of age to complete Section B of this form.
101 Hospital Street 29 State House Station
Augusta, Maine 04333
207-624-9000 ext. 52114 TTY Users Call Maine Relay 711
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