(a) A birth that occurred four or more years before the date of the application for registration shall be recorded on a form entitled “Delayed Certificate of Birth.” The department shall prescribe and furnish the form.
(b) The form shall provide for:
(1) the name and sex of the person whose birth is to be registered;
(2) the place and date of the person’s birth;
(3) the names of the person’s parents;
(4) the place of birth of each parent;
(5) the date of registration; and
(6) any other information required by the state registrar.

(c) The information on the form must be subscribed and sworn to, before an official authorized to administer oaths, by:
(1) the person whose birth is to be registered; or
(2) the person’s parent, legal guardian, or legal representative if the person is incompetent to swear to the information.
(d) The state registrar shall add to a certificate submitted under this section:
(1) a description of each document submitted in support of the delayed registration, including the title of the document or the type of document;
(2) the name and address of the affiant if the document is an affidavit of personal knowledge; and
(3) if the document is a record, or certified copy of a record, of a business entry:
(A) the name and address of the custodian of the record;
(B) the date of the original entry; and
(C) the date of the certified copy.