Maternal Biological Creator’s Given Name/s:
Maternal Biological Creator’s Family Name:
Paternal Biological Creator’s Given Name/s:
Paternal Biological Creator’s Family Name:
Time Born (if unknown, put “Not Known”):
Place Where Born:
I the undersigned certify that the information indicated on this form is true and accurate. I further certify that the Declaration of Living Status is to be recorded by the People’s Court of Terra Australis for preservation in the Book of Deeds.
I understand that by submitting this declaration online, I have agreed to the electronic autograph below and that this application shall have the same legal effect as if made under oath. I am also aware that by submitting false information on this application I would be guilty of committing perjury, for which I may be prosecuted. I accept full liability for this submission.
Autograph of Living Man/Woman
Email Address of Living Man/Woman
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