Application For Florida Birth Record (Page 2 of 2) in pdf

INFORMATION AND INSTRUCTIONS FOR BIRTH RECORD APPLICATION

COMPUTER CERTIFICATION: computer certifications are accepted by all state and federal agencies and used for any type of travel.

A computer certification has

two

different formats:

1. A certification of a registered birth (2004 to present). supplies the follOl,,;ng facts of birth: Child's Name, Date of Birth, Sex,

Time, Weight, Place of Birth (City, County and Location) and Parents' Information.

2. A certification of a registered birth (1930 to 2003), supplies the following facts of birth: Child's Name, Date of Birth, Sex,

County of Birth and Parents' Name.

AVAILABILITY: Birth registration was not required by state

law

until 1917, but there are some records on file dating back to 1865.

ELIGIBILITY: Birth certificates can be issued only to:

Registrant (the child named on the record) if of legal age (18)

Parent(s) listed on the Birth Record

Legal guardian (must provide guardianship papers)

Legal representative of one of the above persons

Other person(s) by court order (must provide recorded or certified copy of court order)

I n the case of a deceased registrant, upon receipt of the death certificate of the decedent, a certification of the birth certificate can

be issued to the spouse, child, grandchild, sibling, if of legal age, or to the legal representative of any of these persons as well as to

the parent.

Any person of legal age may be issued a certified copy of a birth record (except for those birth records under seal) for a birth event

that occurred over 100 years ago.

BIRTH RECORDS UNDER SEAL:

Birth records under seal by reason of adoption, paternity determination or court order cannot

be ordered in the usual manner. For a record under seal, write to:

OFFICE OF VITAL STATISTICS

ATTN: Records Amendment Section

BOX210

Jacksonville,

FL 32231-0042

REQUIREMENT FOR ORDERING: If applicant is self, parent, legal guardian or legal representative, the applicant must provide a

completed application along with valid photo identification, if a mail request, a copy of the valid photo identification must be

provided. If legal guardian, a copy of the appointment orders must be included with the request. If legal representative, the

attorney bar number, and a notation of whom the attorney represents and that person's relationship to the registrant must be

included with your request. If you are an agent of local, state or federal agency requesting a record, indicate in the space provided

for "relationship" the name of the agency. Acceptable forms of identification are the following:

Driver's License, State

Identification Card, Passport and/or Military Identification Card.

If not one of the above, you must complete this application and have a notarized Affidavit to Release A Birth Certificate (DH 1958,

2/03) submitted with your application for the birth record along with a copy of the registrant's valid photo identification as well as the

applicant's valid photo identification.

RELATIONSHIP TO REGISTRANT: A person ordering his or her own certificate should enter "SELF" in this space. Also, explain if

name has been changed; married name, name changed legally (when and where), etc. Others must identify themselves clearly as

eligible (see ELIGIBILITY above).

NONREFUNDABLE: Vital record fees are nonrefundable.

APPLICANT'S SIGNATURE: Is required, as well as his/her printed name, residence address and telephone number

IF THE CERTIFICATION IS TO BE MAILED TO ANOTHER PERSON OR ADDRESS,

USE THE SPACES BELOW TO SPECIFY SHIP TO NAME AND ADDRESS.

PLEASE TYPE

SHIP TO NAME'

(

)

(

)

FIRST

MIDDLE

LAST

SUFFIX

HOME PHONE NUMBER

SHIP TO STREET ADDRESS (AND APT.)

WORK PHONE NUMBER

CITY

STATE

ZIP

PLEASE VISIT THE OFFICE OF VITAL STATISTICS WEBSITE

DH 1960,06/13 64V-1.0131, Florida Administrativt Codt (Obsoldts Pnvious Editions)

Application For Florida Birth Record Page 2

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