NOTE: Only records pertaining to a license purchased in Orleans parish are available through the registry. In all parishes, except Orleans, certified copies of marriage certificates may be obtained from the clerk of court in the parish of license purchase.
AFFIDAVIT OF IDENTITY
STATE OF LOUISIANA
PARISH OF_______________________ BEFORE ME, the undersigned notary, duly qualified, personally cam and appeared ____________________who, being by me first duly sworn, deposed and said that:
My full legal name is ___________________, I was born on the ___________day of_____________, 19_______, in __________________ Parish/City. My mother's maiden name was ___________________ and she born in _______________ Parish/City. The information contained within this affidavit is truthful and accurate to the best of my knowledge and belief.
___________________________
SIGNATURE OF AFFIANT
SWORN TO AND SUBSCRIBED BEFORE ME, this ________ day of ______________________, 19_______,
__________________
NOTARY PUBLIC
CONFIRMATION OF IDENTITY STATEMENT
TO: Registrar of Vital Records
FROM: (Name of qualifying organization)
DATE: (Date of execution of statement)
I have been designated by _____________________ (QUALIFYING ORGANIZATION), _______________________(STREET ADDRESS), _______________(CITY), Louisiana, ______(ZIP CODE), ____-__________________ (TELEPHONE NUMBER), to execute this statement on behalf of ___________________________ (REQUESTOR'S NAME).
MR./Mrs./Ms. ________________________ (REQUESTOR'S NAME), has had a sufficient on-going relationship with the ________________________(QUALIFYING ORGANIZATION) to establish identity.
(Additional relevant information may be included).
__________________ (AGENTS'S SIGNATURE)
__________________ (POSITION WITH QUALIFYING ORGANIZATION)
APPLICATION FOR REGISTRATION AS A QUALIFYING ORGANIZATION
_____________________, 19_____
Org. Name
Org. Address
Mailing Address
If Different
Org. Phone #
Documentation of Existence
(List Type & Attach Copies)
Name, Signature, and Position of Person(s) Authorized to Execute Confirmation of Identity Statements
NAME: POSITION:
SIGNATURE:
NAME: POSITION:
SIGNATURE:
NAME: POSITION:
SIGNATURE:
Concise Description of Org. Goals/Purposes:
Signature of Person Completing
Form for Qualifying Organization:
******************************************************
DO NOT WRITE BELOW THIS LINE
() Approved () Disapproved
Date:, 19
Signature of
Registrar:
La. Admin. Code tit. 48, § V-11707