AFFIDAVIT OF ABSENT OR MISSING PARENT The applicant will be required to submit a notarized affidavit in the event they indicate that they cannot locate or have had no contact with the named individual with respect to the request for a Change of Name or Birth Certificate Amendment for a minor. NAME OF APPLICANT AND RELATIONSHIP TO THE MISSING OR ABSENT PARENT NAME OF THE MISSING OR ABSENT PARENT LAST KNOWN ADDRESS(ES) OF THE MISSING OR ABSENT PARENT LAST KNOWN CONTACT WITH THE MISSING OR ABSENT PARENT NAME, TELEPHONE NUMBER AND DATE OF EACH INDIVIDUAL CONTACTED REGARDING THE MISSING OR ABSENT PARENT (FRIENDS, FAMILY, NEIGHBORS) NAME AND INFORMATION RECEIVED FROM EACH INDIVIDUAL CONTACTED NAME, TELEPHONE NUMBER AND DATE OF EACH HOSPITAL CHECKED NAME OF EACH INDIVIDUAL CONTACTED AND THE INFORMATION RECEIVED NAME, TELEPHONE NUMBER AND DATE OF EACH DEPARTMENT OF CORRECTIONS CONTACTED NAME OF EACH INDIVIDUAL CONTACTED AND THE INFORMATION RECEIVED NAME, TELEPHONE NUMBER AND DATE OF EACH POLICE AGENCY CONTACTED American LegalNet, Inc. www.FormsWorkFlow.com NAME OF EACH INDIVIDUAL CONTACTED AND THE INFORMATION RECEIVED DATE AND NAME OF EACH TELEPHONE BOOK CHECKED DATE AND NAME OF EACH INTERNET SEARCH ENGINE CHECKED INFORMATION RECEIVED FROM EACH INTERNET SEACH ENGINE ADDITIONAL INFORMATION DATE: ___________________________ ___________________________________________ PRINT APPLICANT’S NAME ________________________________________________ SIGNATURE OF APPLICANT _______________________________________________ ADDRESS OF APPLICANT ________________________________________________ ________________________________________________ TELEPHONE NUMBER SUBSCRIBED AND SWORN TO THIS _______ DAY OF ______________________________ 20_____. NOTARY PUBLIC: __________________________________________________________________. COMMISSION EXPIRES: _____________________________________________________________. CREATED JANUARY 2011 American LegalNet, Inc. www.FormsWorkFlow.com