Correction of Birth Record - Fairfield County Court of Common Pleas

Case Number Day appeared in probate court Month appeared in probate court Year appeared in probate court Applicant who appeared Full Name of Child Date of Birth Place of Birth city and county Parent one name Parent two name Parent one place of birth Parent one date of birth Parent two place of birth Parent two date of birth Item one Item one reads as Item one should read Item two Item two reads as Item two should read Item three Item three reads as Item three should read Item four Item four reads as Item four should read Applicant address Sworn day Sworn month Sworn year Official Character Probate Judge

In the Matter of the Correction of Birth Record of Name of Applicant at Birth Attending Physician Attending Physician address Physician affidavit day Physician affidavit month Physician affidavit year Official Title for physician affidavit Affiant one age Affiant one relationship or facts showing personal knowledge Affiant one address Affidavit one day Affidavit one month Affidavit one year Official Title for affidavit one Affiant two age Affiant two relationship or facts showing personal knowledge Affiant two address