Requisition For Texas Vital Statistics Forms (Page 2 of 2) in pdf

Available on

Name of Current Vital Statistics Forms

Form No.

Rev Date

Website

Requisition for Vital Statistics Forms*

VS-100

09/11

YES

Batch Control Form*

VS-101

10/04

Mother’s Worksheet (2005)*

VS-109.1

09/11

YES

Mother’s Worksheet (2005)* (Spanish)

VS-109.1A

02/05

YES

Medical Worksheet (2005)* {§192.003}

VS-109.2

09/11

YES

2005 Certificate of Birth-Long Form (restricted distribution)

VS-111

01/05

Certificate of Death (restricted distribution)

VS-112

04/09

Certificate of Fetal Death

VS-113

01/06

Report of Death*

VS-115

09/04

YES

Burial-Transit Permit (restricted distribution)

VS-116

09/04

Court-Ordered Delayed Certificate of Death

VS-128

02/01

Notice of Intent to Claim Paternity*

VS-130

2/10

YES

Paternity Registry Notice of Change of Information*

VS-131

12/05

YES

Revocation of Notice of Intent to Claim Paternity*

VS-132

12/05

YES

06/15

Paternity Registry Inquiry Request*

VS-134

YES

Acknowledgment of Paternity Inquiry Request *

VS-134.1

09/11

YES

09/15

Application for Certified Copy of Birth or Death Record*

VS-142.3

YES

Application for Birth/Death Verification Letter*

VS-143

12/05

YES

Request for Gift Certificate for Heirloom Birth Certificate*

VS-144

12/05

YES

Adult Adoptee Application Non-Certified Copy of Original

VS-145

12/05

YES

BC*

Rescission of Acknowledgement of Paternity

VS-158

09/11

Acknowledgement of Paternity

VS-159.1M

09/11

Certificate of Adoption*

VS-160

02/11

YES

07/15

Information on Suits Affecting the Family Relationship*

VS-165

YES

03/16

Application for a New Birth Certificate Based on Parentage*

VS-166

YES

Inquiry of Court of Continuing Jurisdiction for a Child*

VS-168

10/04

Yes

05/15

Application to Amend Certificate of Birth *

VS-170

YES

07/15

Application to Amend Certificate of Death*

VS-172

YES

Amendment to Medical Certification of Certificate of Death

VS-174

01/09

06/15

Application for Marriage License*

VS-180

YES

06/15

Declaration and Registration of Informal Marriage*

VS-180.1

YES

Application for Disinterment Permit and Consents*

VS-271

05/99

YES

Cemetery Consent Form*

VS-271.1

07/05

YES

Certificate of Birth Resulting in Stillborn Application*

VS-301

12/05

YES

05/15

Application for Amended Birth Certificate Based on a Court

VS-2318.1

YES

Ordered Change of Name*

BVS Postage paid envelope (Large Only)

25% White New Cotton 8 ½ x 11 – TER-Death

Native Texan Heritage Heirloom Birth Certificate and

YES

Commemorative Wedding Anniversary Certificate Brochure

* Only these forms bolded and noted with an asterisks (*) may be duplicated for use in your office *

MAKE COPIES OR DOWNLOAD THESE FORMS

All Others Forms Must be Vital Statistics Originals

Forms on the Website:

VS-100 Rev. 04/2016

Texas Department of State Health Services - Texas Vital Statistics

Requisition For Texas Vital Statistics Forms Page 2

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