Age Declaration Form: Notarization, DS-10, and Submission

An age declaration form is a sworn written statement establishing your date of birth when you cannot produce a birth certificate. You fill in your identifying details and date and place of birth, sign the statement before a notary (or under penalty of perjury for most federal filings), attach supporting records such as a Letter of No Record and early school or religious documents, and submit the package to the agency that asked for proof of age. Because the statement is sworn, lying on it is federal perjury, punishable by up to five years in prison.¹

When You’ll Be Asked for One

Agencies and private institutions request a sworn age statement whenever they need proof of age and your birth certificate is missing, destroyed, or was never filed. The most frequent situations:

Passport applications, where the State Department uses its own Form DS-10 for applicants born in the United States with no acceptable birth certificate.²
Social Security number and benefit applications, where the SSA accepts secondary evidence of age if no birth certificate or early religious record is available.³
Voter registration, in states that require proof of age at registration.⁴
Employment of minors, where state child labor laws often require an age certificate before a worker under 18 can be hired. An employer who relies in good faith on that certificate has a defense if the worker turns out to be underage.⁵
Insurance and pension enrollment, marriage license applications, and some court proceedings where date of birth is in dispute.

No universal template exists. The exact form depends on the agency asking for it and the state you live in, so always start with the specific instructions from whoever is requesting the document.

What to Put on the Form

Nearly every age declaration follows the same structure. Missing or garbling any of these pieces is the fastest way to get the document returned.

A clear title such as “Affidavit of Age Declaration” or “Sworn Declaration of Date of Birth.”
Your full legal name, current address, and any identifying number the agency uses (Social Security number, case number, application reference).
A specific, unambiguous statement of the day, month, and year of birth, together with the city, county, and state (or country) where the birth occurred.
The full legal names of both parents, which lets the agency cross-check against surviving records.
A one-sentence purpose statement, for example: “This affidavit is submitted in support of my application for a U.S. passport.”
An attestation clause. For federal purposes, 28 U.S.C. § 1746 supplies the required wording: “I declare under penalty of perjury that the foregoing is true and correct.”⁶
Your signature, dated the same day the notary signs.
A notary block with space for the notary’s signature, seal, commission expiration date, and the jurisdiction of the notarization.

If someone else is signing on your behalf, such as a parent attesting to a child’s birth, the form also needs that person’s full name, their relationship to you, and an explanation of how they have personal knowledge of the birth.²

Supporting Documents to Attach

A sworn statement on its own is rarely enough. Agencies treat the affidavit as the weakest form of secondary evidence, and most expect at least one or two corroborating records in the same package. The stronger the supporting file, the less likely the declaration will be challenged.

A delayed or amended birth certificate, if your birth was eventually recorded late.
A Letter of No Record from the vital records office in the state where you were born, confirming that no birth certificate exists. The State Department specifically requires this when DS-10 is used.²
Early religious records such as a baptismal certificate created within a few years of birth.
School enrollment forms or transcripts from early schooling that list your date of birth.
Hospital admission records from the birth, or early vaccination records.
Life insurance policies or applications written shortly after birth that record a date of birth.
State census entries listing you with an age or birth year.

The Social Security Administration, for instance, wants a birth certificate or religious record made before you turned five, and if neither exists it asks for at least two of the documents above.³ Any foreign-language record should be submitted with a certified English translation.

How to Sign and Notarize It

Filling out the form is the easy part. Signing it correctly is where things fall apart.

In Person Before a Notary

You sign the declaration in the physical presence of a notary public or other official authorized to administer oaths.⁷ The notary will ask you to swear or affirm that the contents are true, watch you sign, and then complete the jurat recording that the oath was taken, the date, and their credentials.⁸ Before you leave, check that the notary dated the jurat, applied the seal, and included their commission expiration date.

Remote Online Notarization

Forty-seven states and the District of Columbia now permit remote online notarization, which lets you appear by live audio-video rather than in person.⁹ You’ll need a valid government-issued photo ID and a device with a camera and microphone. Confirm first that the agency receiving your form accepts remotely notarized documents, because a few older processes still insist on a wet-ink signature and physical seal.

The Federal “No Notary” Option

For most federal filings and federal court submissions, you can skip the notary. Under 28 U.S.C. § 1746, a written statement signed under penalty of perjury carries the same legal force as a notarized affidavit, provided it includes the required language: “I declare under penalty of perjury that the foregoing is true and correct. Executed on [date].”⁶ State courts and state agencies may still require a notarized affidavit, so check the specific instructions.

Notary Fees

Every state caps what a notary can charge for an oath on an affidavit. Caps range from $2 in states like Georgia and New York to $25 in Rhode Island, with most states falling between $5 and $15. Remote online notarization usually has a separate, higher cap, up to about $25 or $30.¹⁰ Notaries can charge less than the cap, and many banks and credit unions notarize for account holders at no cost.

The Passport Version: Form DS-10

The passport application is the single most common reason people need a formal age declaration, and the State Department has its own form for it: DS-10, Birth Affidavit. One important twist: the passport applicant does not sign DS-10. Someone else does, on the applicant’s behalf.

The affiant must be a close blood relative, such as an older sibling, or someone directly involved in the birth, such as the attending physician. That person records what they personally remember: the date, time, and place of birth, who was present, the names of both birth parents, and the affiant’s relationship to the applicant.²

The affiant signs DS-10 in front of a passport agent, passport acceptance agent, or notary public, and submits a clear photocopy of the front and back of their government-issued photo ID. The applicant separately submits:

A delayed birth certificate or a Letter of No Record from the state vital records office.
Early public records such as a baptismal certificate, hospital birth record, or school records.
The completed DS-10.
Form DS-11, Application for a U.S. Passport.

Passport fraud carries steeper consequences than ordinary perjury: up to 10 years in prison for a first or second offense, and up to 25 years if the false statement was made to facilitate international terrorism.¹¹

Submitting the Package

Where you send the completed, notarized declaration depends on who asked for it. Electoral offices, Social Security offices, insurers, and courts each have their own channels. A few practices apply across all of them.

Submit originals or certified copies, not photocopies. The SSA specifically states it cannot accept photocopies or notarized copies, and returns originals after review.³
For irreplaceable records such as foreign birth records or immigration documents, deliver in person if you can. The SSA warns against mailing Department of Homeland Security documents because they are hard to replace if lost.³
If you mail the package, include your Social Security number, case number, or application reference on a separate sheet inside the envelope. Don’t write on the original documents.
Photocopy everything before it leaves your hands: the declaration, every supporting document, and the notary’s jurat.

Processing times vary. A straightforward birth certificate order can take a couple of weeks; a request to amend a birth record or process an immigration petition can take months. Follow up with the specific agency if you haven’t heard anything within the window they quoted.

Why Declarations Get Rejected

Rejections are common, and the reasons are almost always avoidable.

Incomplete notarization: no seal, no commission expiration date, or the jurat date doesn’t match your signature date.
Inconsistent dates between the declaration and the supporting documents. Even a one-digit mismatch can trigger a kickback.
No supporting evidence at all. A bare affidavit is usually not enough.
Wrong affiant. For DS-10, the signer must have personal knowledge of the birth. A friend you met in adulthood doesn’t qualify.
No Letter of No Record or other explanation of why the primary record doesn’t exist. Agencies want to see that you tried to get the birth certificate first.

Penalties for a False Statement

A declaration signed under oath, or under penalty of perjury per 28 U.S.C. § 1746, triggers the federal perjury statute when it goes to a federal agency. Under 18 U.S.C. § 1621, willfully stating something you don’t believe to be true carries up to five years in federal prison, a fine, or both.¹ The unsworn declaration shortcut does not reduce the criminal exposure.⁶

Context-specific penalties can be worse. A false claim of U.S. citizenship carries up to five years under 18 U.S.C. § 1015.¹² A false statement in a passport application can mean up to 10 years for a first offense.¹¹ A perjury conviction is a permanent federal felony that follows you into future employment, professional licensing, and immigration decisions.

If you’re uncertain about a specific detail, say so on the form. Qualifiers like “to the best of my knowledge and belief” exist for exactly that situation, and using them honestly is far safer than guessing at a precise date you don’t actually remember.

1
Office of the Law Revision Counsel. 18 USC 1621 – Perjury Generally
2
U.S. Department of State. Birth Affidavit (Form DS-10)
3
Social Security Administration. Proof Of Your Age
4
New Hampshire Secretary of State. Register to Vote
5
U.S. Department of Labor. Employment/Age Certificate
6
Office of the Law Revision Counsel. 28 USC 1746 – Unsworn Declarations Under Penalty of Perjury
7
National Institute of Justice. Law 101 – Legal Requirements of an Affidavit
8
Pennsylvania Department of State. Sample Notary Public Statements
9
National Association of Secretaries of State. Remote Electronic Notarization
10
Notary Public Association. Notary Fees by State
11
Office of the Law Revision Counsel. 18 USC 1542 – False Statement in Application and Use of Passport
12
Office of the Law Revision Counsel. 18 USC 1015 – Naturalization, Citizenship or Alien Registry