Washington State Department of Health - Vital Records Forms · Washington state form
Supporting Affidavit for Births (DOH 422-036)
Use this affidavit to provide information about a child’s birth, the parents, and your relationship to the child, based on your personal knowledge.
- What this form is
- The Supporting Affidavit for Births asks an affiant to provide details about a child’s birth, including the date, location, parents’ birth names, and the affiant’s relationship to the child. The affiant must explain how they know the birth details are true and provide specific information about the birth location and people present. The form includes a notary section for the affiant’s signature.
- Who needs it
- A person with personal knowledge of a child’s birth may use this affidavit to provide birth details and explain their relationship to the child.
- Why it needs a notary
- The affiant’s signature must be notarized. This can be done online with a commissioned online notary.
- How to submit it
- Submit it to the Washington State agency named on the form.
Questions
What information does the Supporting Affidavit for Births request?
The affidavit asks for the child’s name, sex, birth date and place, parents’ birth names and birthplaces, your relationship to the child, and how you know the birth details are true.
Does the Supporting Affidavit for Births need to be notarized?
Yes. The form includes a section for the affiant to sign before a notary public. Notarization can be done online with a commissioned online notary.
What does the form mean by personal knowledge?
The form defines personal knowledge as having observed the child’s mother in an apparent pregnant state within two months before the birth and in a non-pregnant state afterward, or having observed the birth.