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Envelope # AFS # Ohio Department of Health VITAL STATISTICS CERTIFICATE OF ADOPTION CHILD'S PERSONAL DATA 1 Name of Child BEFORE Adoption 2 Date of Birth (Month, Day, Year) 3 Sex 4 Place of Birth (City, County, State or Foreign Country) Child's Name After Adoption First Name Middle Name Last Name ADOPTIVE PARENT(S)' PERSONAL DATA The following information provided below will be used to create the new birt.
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Birthing FAQ
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I hereby declare that the information given above and in the enclosed documents is true to the best of my knowledge and belief and nothing has been concealed therein. I understand that if the information given by me is proved false/not true, I will have to face the punishment as per the law.
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to say in a formal or official way, usually in the form of an official document, that something is true or correct: [ + (that) ] I hereby certify (that) the above information is true and accurate. [ + noun/adj ] The man was certified (as) dead on arrival at the hospital.
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I HEREBY CERTIFY that the information provided in this form is complete, true and correct to the best of my knowledge.
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certify that the above facts are true to the best of my knowledge and belief and I understand that I subject myself to disciplinary action in the event that the above facts are found to be falsified.
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I certify that to the best of my knowledge and belief all of the information on this form is correct. I also understand that failure to report completely and accurately may result in sanctions under my policy, including but not limited to voidance of the policy, and in criminal or civil penalties (18 U.S.C.
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I, THE UNDERSIGNED [name of the authority], hereby certify that the attached text is a true and complete copy of [title of the treaty, name of the parties, date and place of conclusion], and that it was concluded in [languages].
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I, THE UNDERSIGNED [name of the authority], hereby certify that the attached text is a true and complete copy of [title of the treaty, name of the parties, date and place of conclusion], and that it was concluded in [languages].
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The term “to the best of my knowledge and belief” is used in affidavits and court documents to indicate that statements being made are not knowingly false.
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