Vital Records Application Form (Page 4 of 5) in pdf

(Q)

Medical insurance card

(R)

Signed federal tax return

(S)

Medical insurance card

(3)

Supporting identification – These items consist of other records or documents that aid examining personnel in

establishing the identity of the applicant. The following items are not all inclusive. The examining or supervisory

personnel may determine that an unlisted document meets the department’s needs in establishing identity.

(A)

Recent utility bill with current address

(B)

Recent paycheck stub

(C)

Recent bank account statement

(D)

Public assistance applications or letters

(E)

Signed valid voter’s registration card

(F)

Police report of stolen identification

(G)

Hospital admission records, immunization records, medical bills.

(H)

Official school transcript

(I)

Bank account statement

(J)

Social Security Letter

(K)

Marriage license

(L)

Divorce decree

(M)

Certified birth certificate from Department of State (FS-240, DS-1350 or FS-545), state other than Texas, District

of Columbia, or other country

(N)

Automobile insurance card

(O)

Lease agreements

(P)

Promissory notes or loan contracts

(Q)

Court order

(R)

Property titles or liens

(S)

Automobile titles

(4)

Every applicant must present:

(A)

One piece of primary identification, or

(B)

Two pieces of secondary identification of different types, or

(C)

One piece of secondary identification plus two pieces of support identification of different types

(5)

Other documents may be presented to enable an otherwise non-qualified applicant capable of obtaining a document for

an individual. Some of these are:

(A)

Notarized authorization form – This is an authorization form signed by the individual authorizing another person

to obtain their documents. The form must be notarized and have a copy of the registrant’s identification attached.

(B)

Foreign court papers that reference an individual may be used to obtain the death certificates for an individual.

Examples of this are wills, probate forms, testamentary letters, property liens and titles, and promissory notes.

(C)

Powers of attorney must either be specific power of attorney authorizing the agent to obtain the documents, or must

be general or durable powers of attorney.

(D)

Documents in a foreign language are acceptable, but must be translated into English. If personnel is not available

that can verify the accuracy of the translation, the documents must be translated by a certified translator (this is the

responsibility of the person requesting the vital record).

(E)

A social worker that is the caseworker for an individual may get their client’s documents for them. They must

present documentation indicating that the registrant is in their care. If the registrant is in the care of an organization

or institution, the documentation must indicate the organization or institution, and the social worker must present

documentation showing they are working on behalf of that organization or institution.

Note: An affidavit must be executed before an official authorized to take oaths or affirmations.

Vital Records Application Form Page 4

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