Ohio > County (Court Of Common Pleas) > Wood > Probate > Correction Of Birth Certificate
Application For Correction Of Birth Record - Ohio
| Application For Correction Of Birth Record Form. This is a Ohio form and can be used in Correction Of Birth Certificate Probate Wood County (Court Of Common Pleas) . |
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Must be typewritten - Do not fold All facts must be given as of Time of Birth CORRECTION OF BIRTH RECORD Application for Correction of Birth Record OHIO Case No.___________ Doc._________ Page_________ In the Court of Common Pleas, Probate Division of ___________________ County, on the ______ day of ______ _________________ 20___ appeared ________________________________________________ praying that his/her (Name of Registrant) birth record be corrected in accordance with Section 3705.20 of the Revised Code, as follows: CHILD Full Name (at time of birth) Exact Place of Birth Name of Father Age of Father (at the time of this birth) Birthplace of Father MOTHER Date of Birth Maiden Name of Mother Age of Mother (at the time of this birth) Birthplace of Mother ? Male ? Female FATHER ITEMS TO BE CORRECTED OR ADDED Item Item Item Item Item Item Item Reads as Reads as Reads as Reads as Reads as Reads as Reads as Should read Should read Should read Should read Should read Should read Should read The undersigned being first duly sworn, says that the facts stated in the foregoing Application are true as he/she verily believes and prays that the Court order the correction of said birth record. _______________________________________________________ Registrant or Applicant Phone Sworn to before me and signed in my presence by the applicant or registrant aforesaid this _____ day of ______ ___________________, 20___. ________________________________________________________ (SEAL) ________________________________________________________ Official Character JUDGMENT ENTRY The Court on consideration of the aforesaid evidence submitted finds and orders that notice of hearing be dispensed with and the birth record of registrant be corrected in accordance with the facts hereinabove set forth; and that a certified copy of the order of the Court be forthwith transmitted to the Director of Health, at Columbus, Ohio, as provided by law. _____________________________________________ Judge I hereby certify the above is a true copy of the application and entry in the foregoing matter. ________________________________________________________ Judge ________________________________________________________ Official Title American LegalNet, Inc. www.USCourtForms.com Supporting Affidavits IN THE MATTER OF THE CORRECTION OF BIRTH RECORD OF STATE OF OHIO, ________________________________________________ Affidavit of Physician The undersigned, being first duly sworn, deposes and says that he was the physician in attendance at the birth of ________________________________________, the applicant herein that he has read the application and that the facts (Name of applicant at birth) stated herein are true as he verily believes. ________________________________________________________ Attending physician ___________________________________________________________________________ Address Sworn to before me and signed in my presence by the said _______________________________________ this ________ day of _____________________, 20___. _____________________________________________ ___________________________________________________________________________ Official Title NOTE: If the affidavit of the attending physician cannot be secured, the application must be supported by the following affidavits of two persons, relative to non-relative, having personal knowledge of the facts. STATE OF OHIO, ________________________________________________ Affidavit The undersigned, being first duly sworn, deposes and says that __he is ______ years of age, that __he has read the application and that __he has personal knowledge of the facts stated therein by reason of being _________________ _________________________________________________________________________________________________ (State relationship, if any, or state facts showing personal knowledge) and that the statements made in the application are true as __he verily believes. ________________________________________________________ Signature of Affiant ___________________________________________________________________________ Address Sworn to before me and signed in my presence by the said _______________________________________ this _________ day of _____________________, 20____. ________________________________________________________ ________________________________________________________ Official Title STATE OF OHIO, ________________________________________________ Affidavit The undersigned, being first duly sworn, deposes and says that __he is ______ years of age, that __he has read the application and that __he has personal knowledge of the facts stated therein by reason of being _________________ _________________________________________________________________________________________________ (State relationship, if any, or state facts showing personal knowledge) and that the statements made in the application are true as __he verily believes. ___________________________________________________________________________ Signature of Affiant ___________________________________________________________________________ Address Sworn to before me and signed in my presence by the said _______________________________________ this _________ day of _____________________, 20____. __________________________________________________________________________ __________________________________________________________________________ Official Title American LegalNet, Inc. www.USCourtForms.com
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