S W O R N A T T E S T A T I O N

Note: Sworn Attestation to be executed/signed by mother/guardian only for the AUSF executed/signed by child ages 7 – 17 years old, fully aware of th...

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SWORN ATTESTATION

I, __________________________________________, _________________ citizen (Mother/Guardian/Affiant’s name)

(Citizenship)

of legal age, with address at __________________________________________________, Canada, after being sworn in accordance with law, do hereby depose and state that I am the mother/guardian, of the affiant in the Affidavit to Use the Surname of the Father (AUSF); that my child/ward _________________________________________________________, is (Name of the child/ward)

fully aware of the consequences of the use of the surname of his/her father.

In witness whereof, I hereby hereunto affixed my signature on this _______ day of ______________________ at Vancouver, B.C., Canada.

______________________________ Signature over Printed Name of the Affiant

SUBSCRIBED AND SWORN to before me this _____ day of __________ in the city of Vancouver, B.C., affiant exhibiting his/her __________________________ issued at _______________________ on _______________________.

__________________________ Administering Officer

Doc. No.

_____________

O.R. No.

______________

S.N.

______________

Fee

______________

Page No.

______________

Book No.

______________

Series of

______________

Note: Sworn Attestation to be executed/signed by mother/guardian only for the AUSF executed/signed by child ages 7 – 17 years old, fully aware of the consequences of the use of the surname of his/her father.