AFFIDAVIT OF OWNERSHIP
State of
County of
RE: Birth Certificate/In Compliance with Minnesota Rule 220 Birth Certificates
I the undersigned, of lawful age and being first duly sworn on oath, depose and state that I am familiar
with the facts recited, and the party named in said birth certificate is the same party as one of the
owners named in said certificate of title.
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Autograph
Signed and sworn to before me on this ____day of___________,2022
____________________________. _____________________________________
Notary Public Commission Expires