Dh Form 430 PDF Details

In the realm of legal documentation and identity verification, the accuracy of one’s birth certificate cannot be overstated. It serves as a foundational identity document, affecting everything from enrollment in schools to obtaining a driver’s license and beyond. The DH 430 form, an essential document governed by Chapter 382 of the Florida Statutes, is designed to facilitate amendments to birth certificates in the state of Florida, ensuring that any inaccuracies or omissions are formally corrected. This form must be completed with precision, using either black typewriter ribbon or clearly printing in black ink, to amend details such as the registrant's full name at birth, the state file number, and corrections to items that were either omitted or incorrectly recorded, including but not limited to the child's full name, mother's maiden name, father's name, and date of birth. The form is structured into several sections, starting with the registrant’s information and followed by a detailed description of errors, what the birth certificate currently shows, and the correct information that should be reflected. To ensure the integrity of the amendment process, the affidavit section of the form must be signed by the registrant if they are of legal age or by a parent or legal guardian if not, with all signatures duly notarized. A notable aspect is the strict prohibition against erasures or alterations on the form, underlining the importance of accuracy in submissions. Furthermore, the statute enforces serious penalties for intentionally false statements, highlighting the legal significance and ramifications of the process. As such, the DH 430 forms a crucial part of maintaining accurate public records and personal documentation in Florida.

QuestionAnswer
Form NameDh Form 430
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesminnesota rule 220 pdf, minnesota rule 220 forms, florida certificate of live birth, minnesota rule 220 affidavit pdf

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INSTRUCTIONS – READ CAREFULLY

Any person who willfully and knowingly makes any false statement on a certificate, record, or report required by Chapter 382, Florida Statutes, or on an application for an amendment thereof, commits a felony of the third degree, punishable as provided in s. 775.084, Florida Statutes.

1.Complete only the upper half of the affidavit. This affidavit will be attached to the original birth certificate thus becoming part of the birth record. Therefore, when completing, please use black typewriter ribbon or print clearly using black ink.

a.REGISTRANT’S FULL NAME AT BIRTH – Enter the registrant’s (person for whom the record is filed) name as it SHOULD APPEAR on the birth certificate.

b.STATE FILE NUMBER – Enter if known, otherwise, leave blank.

c.BIRTH DATE AND BIRTH PLACE – Enter correct date and place of birth of registrant.

d.COLUMN 1 “ITEM OMITTED OR IN ERROR” – List the item(s) in error. Child’s Full Name, Mother’s Maiden Name, Father’s Name, Date of Birth, etc.

e.COLUMN 2 “BIRTH CERTIFICATE SHOWS” – Enter the information that is currently shown on the birth certificate.

f.COLUMN 3 “SHOULD BE” – Enter the correct information. There are enough lines to make four corrections. If more than four cor- rections are indicated, you may enter two items per line thus allowing for eight corrections

2.Affidavit must be signed by registrant if of legal age of 18 or if not of legal age by parent(s) or legal guardian in the presence of a notary public. IF CORRECTION IS TO THE REGISTRANT’S NAME AND THE REGISTRANT IS UNDER THE AGE OF 18, THE AFFIDAVIT MUST BE SIGNED BY BOTH MOTHER AND FATHER< BOTH SIGNATURES MUST BE NOTARIZED.

3.AFFIDAVIT NOT ACCEPTABLE IF ERASURES OR ALTERATIONS ARE MADE.

IF ASSISTANCE IS NEEDED IN CONNECTION WITH THIS AMENDMENT, CONTACT THIS OFFICE AT (904) 359-6900, Ext. 9005.

AFFIDAVIT OF AMENDMENT OF CERTIFICATE OF LIVE BIRTH

(READ INSTRUCTIONS ABOVE BEFORE COMPLETING AND SIGNING)

REGISTRANT’S FULL NAME AT BIRTH

 

 

 

STATE FILE OR BIRTH NUMBER

 

 

 

 

 

109 -

 

 

DATE OF BIRTH

 

PLACE OF BIRTH/CITY OR TOWN

 

COUNTY

 

STATE

MONTH/DAY/YEAR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FLORIDA

 

 

 

 

 

 

 

 

ITEM OMITTED OR IN ERROR

 

BIRTH CERTIFICATE SHOWS

 

SHOULD BE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I HEREBY DECLARE UPON OATH THAT THE ABOVE STATEMENTS ARE TRUE AND CORRECT

Personally Known _ or Produced Identification _

SIGNATURE

 

 

 

Type Identification Produced _____________

___________________________________________________________________________

 

_____________________________________

 

 

 

 

 

 

 

 

 

 

 

COMMISSION EXPIRES: ________________

SUBSCRIBED AND SWORN BEFORE ME THIS

 

___________________________________

 

 

 

 

 

 

 

(Signature of Notary)

SEAL

 

 

____ day of _____________________, 20____

 

 

 

 

 

 

 

 

 

_____________________________________

 

 

 

 

 

 

 

(Printed Name of Notary)

 

 

 

I HEREBY DECLARE UPON OATH THAT THE ABOVE STATEMENTS ARE TRUE AND CORRECT

Personally Known _ or Produced Identification _

SIGNATURE

 

 

 

Type Identification Produced _______________

___________________________________________________________________________

 

______________________________________

 

 

 

 

 

 

 

 

 

 

 

COMMISSION EXPIRES: ________________

SUBSCRIBED AND SWORN BEFORE ME THIS

 

___________________________________

 

 

 

 

 

 

 

(Signature of Notary)

SEAL

 

 

____ day of ___________________, 20____

 

 

 

 

 

 

 

 

 

____________________________________

 

 

 

 

 

 

 

(Printed Name of Notary

 

 

 

DH Form 430, 5/04 (Replaces previous additions which may not be used) (Stock Number 5740-000-0430-8)

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