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Get FL DH 743A 2015-2024

020 Obsoletes Previous Editions INSTRUCTIONS FOR AFFIRMATION OF COMMON CHILD REN This form is not to be recorded in official records and must be sent with the Certificate of Marriage that has been filed and recorded in accordance with 741. INFORMATION BELOW FOR USE BY VITAL STATISTICS ONLY NOT TO BE RECORDED STATE OF FLORIDA Department of Health - Office of Vital Statistics AFFIRMATION OF COMMON CHILD REN BORN IN FLORIDA TYPE OR PRINT INFORMATION Marriage Application Number SPOUSE S NAME First Middle Last SPOUSE S MAIDEN SURNAME If different Date of Birth mm/dd/yyyy Birthplace State/Country In accordance with 741. 01 Florida Statutes we hereby attest that we are the parents of the following minor child ren born in the State of Florida* Name of child As appears on Birth Certificate Birth Certificate number if known Place of birth City County State Florida State of Personally Known OR Produced identification Type of Identification Produced. BY OUR SIGNATURES we do hereby swear and affirm that all of the information contained herein is true and correct and may be relied upon for the issuance of a marriage license. Spouse s signature SWORN to and subscribed before me this day of Signature of Deputy Clerk or notary Print or Type Deputy Clerk s Name or notary SEAL DH 743A 01/2015 Florida Administrative Code Rule 64V-1. 01 Florida Statutes. All information should be printed or typed and follow the format that is provided for each field. 01 Florida Statutes we hereby attest that we are the parents of the following minor child ren born in the State of Florida* Name of child As appears on Birth Certificate Birth Certificate number if known Place of birth City County State Florida State of Personally Known OR Produced identification Type of Identification Produced. BY OUR SIGNATURES we do hereby swear and affirm that all of the information contained herein is true and correct and may be relied upon for the issuance of a marriage license. BY OUR SIGNATURES we do hereby swear and affirm that all of the information contained herein is true and correct and may be relied upon for the issuance of a marriage license. Spouse s signature SWORN to and subscribed before me this day of Signature of Deputy Clerk or notary Print or Type Deputy Clerk s Name or notary SEAL DH 743A 01/2015 Florida Administrative Code Rule 64V-1. 01 Florida Statutes we hereby attest that we are the parents of the following minor child ren born in the State of Florida* Name of child As appears on Birth Certificate Birth Certificate number if known Place of birth City County State Florida State of Personally Known OR Produced identification Type of Identification Produced. BY OUR SIGNATURES we do hereby swear and affirm that all of the information contained herein is true and correct and may be relied upon for the issuance of a marriage license. Spouse s signature SWORN to and subscribed before me this day of Signature of Deputy Clerk or notary Print or Type Deputy Clerk s Name or notary SEAL DH 743A 01/2015 Florida Administrative Code Rule 64V-1. .

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