BPS Birth Certificate Affidavit

NEW MEXICO
AFFIDAVIT OF REVIEW OF A CERTIFIED NEW MEXICO BIRTH CERTIFICATE
This form is to be used only by the Department of Health to validate Birth Certificate information. Do not accept this in place of a birth certificate.

This document is to verify that I have witnessed and reviewed a true and original certified copy of the CERTIFICATE OF BIRTH issued by the State of New Mexico. In accordance with Section 24-14-27 of the New Mexico Vital Statistics Act, it is unlawful for any person to copy or issue a copy of all or part of any vital record except as authorized by law.
Printed Name and Title of person verifying the presented certified New Mexico CERTIFICATE OF BIRTH*
Full Name and Title
I do hereby certify that I have witnessed an original certified State of New Mexico Certificate of Birth for:

Name of Document: CERTIFICATE OF BIRTH, STATE OF NEW MEXICO
Name of Person Registered:*

First NameMiddle NameLast Name
Date of Birth:*

MonthDayYear
Date
Mother Name:*
Father Name:*
File No.:*
Date of Registration:*

MonthDayYear
Date
Certificate Control No.:*
Signature of Verifier:

Clear
Date:*

MonthDayYear
Date
BPS School Site:*
Daytime Telephone Number*
Verifier Name: This is the name of the person from your Provider/ Clinic who has witnessed the certified New Mexico Certificate of Birth.

Title: is the capacity in which they are performing this duty. Provider/ Clinic: This is the practice name or NMSIIS PIN where document was witnessed.

School Site: This is the School Site name where the document was witnessed.

File Number and Date of Registration: The file number and date of registration appear on all computer generated certified copies issued since 1984. All certified copies bear the gold embossed great seal of the State of New Mexico. To aid in the authenticity of a presented certificate, verify that the raised state seal is also visible from the back of the certificate.

Certificate Control No.: This is the number in red located on birth certificate; the control number is a security feature that allows the ink to "bleed through" to the back of the certificate. To aid in the authenticity of the verified document, verify that the red ink on control number is also visible from the back of the certificate.

To talk to the New Mexico Department of Health NMSIIS Helpdesk about concerns or problems with a NMSIIS record: 1-833-882-6454 or fax: 505-476-3128

New Mexico Department of Health 1.1.22

Public Health Division

1190 St. Francis Dr., Suite 1050 PO Box 26110 Santa Fe, New Mexico 87502

(505) 827-2389 FAX: (505) 827-2329 www.nmhealth.org
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NEW MEXICO

AFFIDAVIT OF REVIEW OF A CERTIFIED NEW MEXICO BIRTH CERTIFICATE