City Of Mcallen Texas Birth Certificate Application printable pdf download

City of McAllen

TEXAS BIRTH CERTIFICATE APPLICATION

VITAL STATISTICS

VOIDS_____________ Copy # ___________________

P.O. BOX 220

(956) 681-1195

VOIDS_____________ Card # ____________________

McAllen, Texas 78505

Date_____________________________________

Please complete all questions and sign application

: _________________________________________________________

Full Name of Person on Record

: _________________________________________________

Date of Birth

Sex { } Male { } Female

Month

Day

Year

________________________________________________________

Place of Birth (City / Hospital):

: _______________________________________________________________

Full Name of Father

: _________________________________________________________

Mother’s full Maiden Name

What is YOUR relationship to the person whose certificate you want: (check one)

{ } Parent

must be listed on certificate

–

(Current US Government issued picture ID* required (not a copy))

{ } Self - must be at least 18 years of age or if a minor, certified copy of marriage license required

(Current

US Government issued picture ID* required (not a copy))

{ } Grandparent

AND

(Proof required: Your son or daughter’s certified birth certificate (not a copy)

YOUR current US

Government issued picture ID*)

{ } Spouse

AND

(Proof required: Certified Copy of Marriage License

current US Government issued picture ID*)

(not a copy)

{ } Brother/Sister – must be at least 18 years of age

(Proof required: Must provide your own certified birth

AND

certificate for verification

US Government issued picture ID*)

( ) Legal Guardian (

Proof required: Court order signed by a US Judge showing legal custody and your own current US

Government issued picture ID*)

Only those listed above are qualified applicants

$23.00 each

Check which certificate you are requesting: { } Certified Copy – Full Sheet - only for those born in McAllen

and/or

Note: If NO RECORD is found, a searching

Fee of $23.00 will be charged. And if both

$23.00 each

{ }

– If born anywhere in the State of Texas

*Abstract (1/2 sheet)

Certificates are checked off, both will be

Abstract available only if names fit

including McAllen

Charged – NO EXCEPTIONS.

Plastic Pouch @ $1.50 each (optional)

PLEASE INDICATE IF THERE HAS BEEN A CHANGE OR CORRECTION ON THE RECORD { } Yes { } No

My purpose to obtain this record is: ________________________________________________________

Indicate What Valid (CURRENT) photo Identification you will present of yourself (REQUIRED):

( ) US Drivers License*

( ) US State Issued ID*

( ) US Passport*

( ) Resident Alien* ( ) Border Crosser*

PLEASE FILL OUT THE FOLLOWING WITH YOUR INFORMATION:

*additional documentation may be needed

Name:

________________________________________________________________________________

Current Physical Address:

_____________________________________________________________

City/State/Zip Code:

___________________________________________________________________

Phone No:

_____________________________________________________________________________

Your Date of Birth as shown on your ID:

_______________________________________________

WARNING: The penalty for knowingly making a false statement on this form can be 2-10 years in prison and a fine of up to

$10,000 (Health and Safety Code, Chapter 195, Sec. 195.003.)

Signature: ______________________________________________________Date:_______________________

NOTE: If you will be mailing in this application to us from outside the RGV but within the USA, you will need to attach a COPY

of both sides of your identification such as one of those indicated above that is not expired along with other required documents,

and a Money Order for our fee (we do not take personal checks for payment on mail requests)&a self-addressed envelope. For

FED EX or UPS ONLY please send to 221 S. 15th, McAllen TX 78501. For Regular, Priority & Express Mail through the US

Postal Service send to P.O. Box 220 McAllen, Texas 78505. We mail requested document back to applicant in an express manner

ONLY through the US Postal Service-a prepaid & self-addressed envelope must be sent along with request. No calling for pick-up

will be done by our office to any shipping service. WE ONLY ACCEPT MAIL REQUESTS FOR THOSE BORN IN McALLEN -

WE DO NOT ACCEPT REQUESTS FROM OTHER COUNTRIES NOR MAIL CERTIFICATES OUT OF THE USA.

City Of Mcallen Texas Birth Certificate Application

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