State of [Your State]

County of [Your County]

AFFIDAVIT

We, the undersigned, being duly sworn, depose and say as follows:

1. Affiant 1:

Name: [Full Name of Affiant 1]

Address: [Full Address of Affiant 1]

Contact Information: [Phone Number, Email Address]

Relationship to Juan Anatoleg: No relation, disinterested party

2. Affiant 2:

Name: [Full Name of Affiant 2]

Address: [Full Address of Affiant 2]

Contact Information: [Phone Number, Email Address]

Relationship to Juan Anatoleg: No relation, disinterested party

Statement of Facts

1. Affiant 1:

I, [Full Name of Affiant 1], declare that I have no personal or familial relationship with
Juan Anatoleg. I have reviewed the birth certificate of Juan Anatoleg and noticed an
error. The error pertains to [describe the specific error, e.g., the misspelling of the name,
incorrect date of birth, etc.]. I affirm that I am familiar with the correct information due to
[state how you came to know the correct information, if applicable, e.g., public records,
known documentation, etc.].

2. Affiant 2:

I, [Full Name of Affiant 2], declare that I have no personal or familial relationship with
Juan Anatoleg. Upon examining the birth certificate of Juan Anatoleg, I identified an
error. The error relates to [describe the specific error, e.g., the wrong name, incorrect
date, etc.]. I confirm that I have knowledge of the accurate information through [explain
 the source of your knowledge, if applicable, e.g., verified documents, public records,
etc.].

Affidavit

We, [Full Name of Affiant 1] and [Full Name of Affiant 2], declare under penalty of perjury
under the laws of the State of [Your State] that the foregoing is true and correct.

Signature of Affiant 1:

Printed Name of Affiant 1:

Date:

Signature of Affiant 2:

Printed Name of Affiant 2:

Date:

Notarization

Subscribed and sworn to (or affirmed) before me on this [day] day of [month], [year], by [Full
Name of Affiant 1] and [Full Name of Affiant 2].

Signature of Notary Public:

Printed Name of Notary Public:

My Commission Expires:
Notary Seal:

Instructions for Use:

1. Replace placeholders (e.g., [Full Name of Affiant 1]) with the actual information.
2. Both affiants must sign the affidavit in the presence of a notary public.
3. Ensure the notary public completes the notarization section.

This affidavit can be used to support a request for correcting the birth certificate of Juan
Anatoleg, documenting that the identified error is known to disinterested parties who have no
personal interest in the matter.

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