South Dakota Department of Health, Office of Vital Records · South Dakota state form
Affidavit of Homeless Status for Certified Copy of Birth Certificate
Use this affidavit to verify homelessness when requesting a fee-exempt certified copy of a South Dakota birth certificate.
- What this form is
- This affidavit documents an individual’s homelessness for a request for a fee-exempt certified copy of their South Dakota birth certificate. The individual and a homeless services provider with knowledge of the individual’s housing status must complete and sign it. Both signatures must be sworn before a notary. The form says the fee-exempt copy is limited to one per lifetime, and a separate Vital Records Request application and applicable identification are still required.
- Who needs it
- A person experiencing homelessness, or an eligible representative applying for them, may use this affidavit with a homeless services provider.
- Why it needs a notary
- The individual’s and homeless services provider’s signatures must be sworn before a notary; this can be done online with a commissioned online notary.
- How to submit it
- Submit the affidavit with the applicable South Dakota Vital Records Request application and identification to any county Register of Deeds office or the Office of Vital Records.
Questions
Who signs the affidavit?
The individual experiencing homelessness and a homeless services provider with knowledge of that person’s housing status must both sign the affidavit.
Do I need a notary for this affidavit?
Yes. The affidavit has a notary jurat for both the individual and the homeless services provider. Each signature must be sworn before a notary, including online with a commissioned online notary.
What else must I submit with the affidavit?
The form says to complete the applicable South Dakota Vital Records Request application and provide the identification required on that application. Submit these with the affidavit to a county Register of Deeds office or the Office of Vital Records.