Free 02718r.pdf - Indiana

OFFICE RECORD CARD
State Form 2718R Child's Name

Child's Address

Place of Birth

Birthdate

Age

Sex

Female Male DOCUMENTS ACCEPTED AS PROOF OF AGE ARE LISTED BELOW IN PREFERENTIAL ORDER (Check method used) 1. Birth Certificate Transcript of Birth Certificate School Records verified by Birth Certificate

FRONT

2. 3.

Baptismal Certificate Family Bible Record

Transcript of Baptismal Certificate showing child's date of birth and place of baptism Passport or Immigration Papers Life Insurance Policy in existence minimum one year

ALL THREE ARE REQUIRED 4. (a.) Sworn statement by public health/public school physician or superintendent attesting to child's physical age (b.) Parent's statement (c.) Available school records Other (specify) Child's Signature Written request for transcript of birth mailed on (date) Issuing Officer's Signature

Fold here

Remark

BACK

Date Of Issue

Certif. No.

Prospective Employer

Address

Work Schedule Days Hrs. Per Per Week Day

Date Terminated Revoked