florida birth certificate application form pdf

@%hgj(H(�B3�u2h�E�=U��ֳo�]�7��%lg�G�:��t��C�ᣰ'X��]��b %��;��"3.Ї�"R�P4ģ��b(X�>TQ�o�V�&r. �A*&�J$4b�� |@FI(C�A� �� If not one of the above, you must complete this application and have a notarized Affidavit to Release A Birth Certificate (DH Form 1958, 08/2010) 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. 7.898 3.4952 Td ET /Tx BMC /Tx BMC EMC If not one of the above, you must complete this application and have a notarized Affidavit to Release A Birth Certificate (DH Form 1958, 08/2010) 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. Acceptable forms of identification are the following: Driver’s License, State Identification Card, Passport, and/or Military Identification Card. @� D�%9 C. ounty. 8.115 3.4952 Td H. ealth . Evidence of Immigration Status. /Tx BMC /Tx BMC Number of Copies Requested: Number of Pairs Requested: Number of Copies Requested: $15.00. /Tx BMC Acceptable forms of identification are a valid state Driver’s License, state ID Card, U.S. Passport, or Military ID Card. endstream endobj 27 0 obj <>/Subtype/Form/Type/XObject>>stream EMC Q endstream endobj 58 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream PART 6 -FEES Includes one certified copy or no-find letter PART 5 -INFORMATION NEEDED TO FIND BIRTH RECORD BEING REQUESTED APPLICATION FOR A CERTIFIED COPY — MICHIGAN BIRTH RECORD Michigan Department of Health and Human Services PART 1 -APPLICANT’S INFORMATION PART 4 -ELIGIBILITY-Select the category that qualifies YOU to request/receive this Michigan birth … /Tx BMC Q If applicant is not one of the above, the Affidavit to Release a Birth Certificate must be completed by an authorized person and submitted in addition to this application form. endstream endobj 51 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 1110 0 obj <>/Subtype/Form/Type/XObject>>stream state charge per transaction (no coins) TOTAL FEES DUE . 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Lauderdale, FL 33315-2643 (954)-467-4. endstream endobj 1090 0 obj <>/Subtype/Form/Type/XObject>>stream EMC /Tx BMC 1 1 42.3085 11.08 re endstream endobj 25 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC /Tx BMC in . /Tx BMC /Tx BMC endstream endobj 49 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC endstream endobj 1119 0 obj <>/Subtype/Form/Type/XObject>>stream EMC /Tx BMC /Tx BMC each. endstream endobj 1104 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 39 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 62 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream /Tx BMC /Tx BMC /Tx BMC BT W /Tx BMC Florida Birth Certificate replacement Application Form. /Tx BMC endstream endobj 1112 0 obj <>/Subtype/Form/Type/XObject>>stream n If not one of the above, you must complete this application and have a notarized Affidavit to Release A Birth Certificate (DH Form 1958, 08/2010) 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. endstream endobj 53 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC IMPORTANT: Read the entire application form before completing. SECTION A: REGISTRANT INFORMATION FIRST MIDDLE LAST P.O. W EMC 0 Main Office at 477 Houston Street, Green Cove Springs. Florida law restricts the issuance of birth certificates. 18 0 obj <> endobj endstream endobj 54 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream /Helv 7.884 Tf endstream endobj 47 0 obj <>/Subtype/Form/Type/XObject>>stream SECTION A: REGISTRANT … EMC endstream endobj 1095 0 obj <>/Subtype/Form/Type/XObject>>stream EMC Acceptable forms of identification are the following: Driver’s License, State Identification Card, Passport, and/or Military Identification Card. /Tx BMC Palm Beach County . EMC Requirement for ordering: If applicant is self, parent, guardian, or legal representative, then the applicant must complete this application and provide photo identification. EMC /Helv 7.912 Tf /Tx BMC EMC Consular Report of Birth, Certificate of Citizenship, or Certificate of Naturalization. W BT 0 g Record Information. ($0.00) Tj EMC �L�@E �@��@�#CP�؁�"T��@��UhY��q�/@��{+1@r;��^ 4��1�m��^5K}V�r牄��љ��#C�=E�-.skLb�d� *�j�hd0 �d( APPLICATION FOR BIRTH CERTIFICATE MOTHER/PARENT DETAILS. /Tx BMC Acceptable forms of identification are the following: Driver’s License, State Identification Card, Passport, and/or Military Identification Card. endstream endobj 52 0 obj <>/Subtype/Form/Type/XObject>>stream %PDF-1.7 %�� Last name * Suffix. EMC /Tx BMC endstream endobj 1093 0 obj <>/Subtype/Form/Type/XObject>>stream APPLICATION FOR FLORIDA BIRTH RECORD For Miami Dade Coun VITAL RECORDS Use Onl aso NW 14th Street Miami, FL 33125 Tel*305-S75£030 ALK4N & ORDERS 8:00 AM to 4:00 PM HOURS: 18680 NW 67th Avenue Hialeah, Fl- 33015 WALK-IN Ot&Y 8:00 AM to 4:30 PM 18256 Homestead Avenue Miami, FL 33157 Tel." Florida Birth Record Application (Creole) Florida Birth Record Application (E spañol) Florida Birth … /Tx BMC EMC EMC Birth Certificate + Birth Card (sold as pair only) Death Certificate. /Tx BMC EMC endstream endobj 24 0 obj <>/Subtype/Form/Type/XObject>>stream h�b```e``1``c`pLe�g@ ~��R;� EMC (0) Tj Has the person on … Q GET THE DOCUMENTS. 0 g EMC S. tatistics . 0 g APPLICATION FOR FLORIDA BIRTH RECORD . In addition to the standard fees for certiﬁcates, the customer must also submit two (2) separate money orders or cashier's … application for a florida death record Any person who willfully and knowingly provides any false information on a certificate, record or report required by Chapter 382, Florida Statutes, or on any application or affidavit, or who obtains confidential information from any Vital Record under false or fraudulent purposes, commits a /Tx BMC If you are applying for someone else (i.e. EMC EMC 28.781 2.3984 Td EMC /Tx BMC Expired forms of identification will not be accepted. RECORDS ONLY To obtain an application for either of these services, visit our website or contact us by telephone. /Tx BMC ET 1 1 85.5746 11.7011 re ET ɸ�"��$�͙�� l#�(9JB�� 0 �j2� ET ($0.00) Tj "��l/��b�*i �%��1�T[! /Helv 8.497 Tf APPLICATION FOR A FLORIDA BIRTH RECORD ALTERNATE PHONE NUMBER HOME PHONE NUMBER FATHER'S / PARENT’S NAME FIRST SECTION B: APPLICANT (adult requesting certificate) INFORMATION SIGNATURE OF APPLICANT IMPORTANT INFORMATION Any person who willfully and knowingly provides any false information on a certificate, record or report required by Chapter 382, Florida Statutes, or on any application … EMC q /Tx BMC D. epartment. %%EOF endstream endobj startxref 800 Clematis Street Phone: (561)837-5847 . 413. EMC endstream endobj 55 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream D8��Dl��@�D�ļ;L�gA�30�#��;��9�! EMC 19.793 3.5831 Td endstream endobj 1087 0 obj <>/Subtype/Form/Type/XObject>>stream D. epartment of . APPLICATION FOR CERTIFIED COPY OF BIRTH/DEATH CERTIFICATE. endstream endobj 45 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC endstream endobj 41 0 obj <>/Subtype/Form/Type/XObject>>stream … endstream endobj 64 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream 1 1 42.3091 11.471 re /Tx BMC /Tx BMC 1141 0 obj <>/Filter/FlateDecode/ID[<47B6844871BA8F41911D258CFEA5983A>]/Index[1077 155]/Info 1076 0 R/Length 165/Prev 233168/Root 1078 0 R/Size 1232/Type/XRef/W[1 3 1]>>stream West Palm Beach, FL 33401 . 1 1 34.768 11.08 re endstream endobj 59 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream EMC /Tx BMC endstream endobj 61 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream Please enter the birth information of the individual who needs the birth certificate. S. tatistics . /Tx BMC endstream endobj 1084 0 obj <>/Subtype/Form/Type/XObject>>stream EMC endstream endobj 1121 0 obj <>/Subtype/Form/Type/XObject>>stream each. EMC EMC endstream endobj 1082 0 obj <>/Subtype/Form/Type/XObject>>stream 0 g EMC Q EMC endstream endobj 43 0 obj <>/Subtype/Form/Type/XObject>>stream EMC EMC EMC 19.677 3.4757 Td EMC endstream endobj 48 0 obj <>/Subtype/Form/Type/XObject>>stream 1 1 34.333 10.124 re endstream endobj 1101 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 56 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream EMC /Tx BMC 1 1 41.8781 10.991 re ($0.00) Tj EMC V�y��=��0 @)/G 19.871 3.4952 Td endstream endobj 46 0 obj <>/Subtype/Form/Type/XObject>>stream BT Box 5135 Tampa, Florida 33675-5135 Florida Birth Record Application. EMC *Certified birth certificates may be issued to: Please note that proof of relationship is required if your name is not listed on the birth certificate: (e.g. ($0.00) Tj endstream endobj 1114 0 obj <>/Subtype/Form/Type/XObject>>stream Birth | Florida Department of Health Free www.floridahealth.gov If applicant is not one of the above, the application must be accompanied with a notarized Affidavit to Release a Birth Certificate (DH Form 1958) signed by one of the above, along with any supporting documentation and a copy of valid photo ID of both the person authorizing release and the applicant … Modified on 10 July 2019 . EMC Download (28 KB) Locations. %%EOF Office of Vital Statistics 8:00AM-4:30PM. q BT /Tx BMC /Tx BMC Applications for certiﬁcates requiring an apostille and/or authentication for recognition by foreign governments can only be made by mail or in-person. n /Helv 12 Tf Box 648 … APPLICATION FOR A FLORIDA BIRTH RECORD Read the FRONT AND BACK of this application: ... you must complete this application and have a notarized Affidavit to Release A Birth Certificate (DH Form 1958, 08/2010) 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. endstream endobj 23 0 obj <>/Subtype/Form/Type/XObject>>stream ET EMC B. roward . W q Birth Certificate. $0.50 . /Tx BMC endstream endobj 1111 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC 0 g Acceptable forms of identification are the following: Driver’s License, State Identification Card, Passport, and/or Military Identification Card. ET APLICATION FOR A FLORIDA BIRTH CERTIFICATE For Miami-Dade VITAL RECORDS Use Only 18680 NW 67th Ave Hialeah, FL 33015 Tel.# 305-628-7227 ONLY IN PERSON 8:00AM to 4:30 PM ONLY IN PERSON 8:00AM to 4:30 PM FIRST, MIDDLE, LAST (INCLUDING ANY SUFIX) SIGNATURE OF APPLICANT Read the Front and Back of this application. D. epartment. APPLICATION FOR A FLORIDA BIRTH RECORD Read the FRONT AND BACK of this application: ... an authorized person and submitted in addition to this application form. /Tx BMC n ($0.00) Tj EMC q F. lorida. EMC Birth Certificate Forms . 1231 0 obj <>stream endstream endobj 1122 0 obj <>/Subtype/Form/Type/XObject>>stream 1077 0 obj <> endobj /Tx BMC APPLICATION FOR FLORIDA BIRTH RECORD Requirement for ordering: If applicant is self, parent, ... the Affidavit to Release a Birth Certificate must be completed by an authorized person and submitted in addition to this application form. APPLICATION FOR A FLORIDA BIRTH RECORD Read the FRONT AND BACK ... Affidavit to Release a Birth Certificate must be completed by an authorized person and submitted in addition to this application form. /Helv 8.207 Tf EMC EMC Q /Tx BMC 20.09 3.4952 Td EMC endstream endobj 1086 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 1115 0 obj <>/Subtype/Form/Type/XObject>>stream EMC n endstream endobj 60 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream Q BT /Tx BMC EMC endstream endobj 1091 0 obj <>/Subtype/Form/Type/XObject>>stream EMC endstream endobj 1126 0 obj <>stream Birth Certificate Forms Documents . (0) Tj Q q h�bbd```b``��A$�mɰ,�!� &�ġ"�1Ԭ�!х$˸ endstream endobj startxref EMC h��[o�:��+�b��E'vZ�I�\�ٳ=ip��J"��m��R��r�Ǯz�"�EQ3C~�7䐦��PDS� I4��P�Qg0� Tc EMC /Tx BMC endstream endobj 1089 0 obj <>/Subtype/Form/Type/XObject>>stream Q endstream endobj 32 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC endstream endobj 1109 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 29 0 obj <>/Subtype/Form/Type/XObject>>stream Name at Birth… $24.00 $7.00. /Tx BMC gu … endstream endobj 34 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC EMC /Tx BMC /Tx BMC /Tx BMC EMC EMC ET EMC EMC (0) Tj B. roward . BT Birth/Death Certificates 813-307-8002 DLCHD29WebsiteDistribution@flhealth.gov Fax. DH 1960, 04/2016, Florida Administrative Code Rule 64V-1.0131 (Obsoletes Previous Editions) SUFFIX SUFFIX SEX SUFFIX SUFFIX ((( and THEIR RELATIONSHIP TO REGISTRANT Applicant’s … 1 1 42.7451 11.08 re W ET endstream endobj 1094 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 1097 0 obj <>/Subtype/Form/Type/XObject>>stream 1 1 34.334 11.08 re n BT endstream endobj 1105 0 obj <>/Subtype/Form/Type/XObject>>stream EMC /Tx BMC City / town of birth * Date of Birth * Name of hospital. /Tx BMC (0) Tj EMC EMC 0 g Birth information of the person on record . EMC /Helv 8.207 Tf EMC APPLICATION FOR FLORIDA BIRTH RECORD Requirement for ordering: If applicant is self, parent, guardian, or legal representative, then the applicant must complete this application and providvalide a copy of a photo identification. /Tx BMC endstream endobj 19 0 obj <> endobj 20 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC/ImageI]/XObject<>>>/Rotate 0/Type/Page>> endobj 21 0 obj <>/Subtype/Form/Type/XObject>>stream Mo nday-F ri day. endstream endobj 1113 0 obj <>/ProcSet[/PDF]>>>>stream /Tx BMC marriage certificates, birth certificates, court orders) The registrant (person named on the certificate) Spouse … 8.788 3.2806 Td q /Tx BMC 0 g /Tx BMC EMC endstream endobj 1123 0 obj <>/Subtype/Form/Type/XObject>>stream 1 1 33.897 11.471 re APPLICATION FOR FLORIDA BIRTH RECORD . endstream endobj 30 0 obj <>/Subtype/Form/Type/XObject>>stream EMC W endstream endobj 1092 0 obj <>/Subtype/Form/Type/XObject>>stream ET q /Helv 8.141 Tf %PDF-1.6 %�� 1.1 First Name at birth. /Tx BMC /Tx BMC /Tx BMC EMC Q EMC q EMC IMPORTANT INFORMATION TO AVOID DELAY: PAGE 2 OF 2 This information is collected by the … VSA 430B 2019/07/11 OTHER SERVICES - Genealogy Certificates and/or Commemorative Certificates - B.C. W EMC Sex *? 0 g the Affidavit to Release a Birth Certificate must be completed by an authorized person and submitted in addition to this application form. /Tx BMC endstream endobj 50 0 obj <>/Subtype/Form/Type/XObject>>stream n HEALTH . C. ounty. 0 g /Helv 8.497 Tf 0 EMC APPLICATION FOR FLORIDA BIRTH RECORD . endstream endobj 65 0 obj <>stream Q /Helv 8.207 Tf EMC endstream endobj 63 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream Hillsborough County Vital Statistics P.O by Mail from Home by Mail from Home record Application ONLY 8:00 AM -3:00.., Certificate of Naturalization Beach County Application in Spanish 780 SW 24 Street, Green Cove.. - B.C SERVICES - Genealogy Certificates and/or Commemorative Certificates - B.C ' N 8:00... Mother/Parent DETAILS Application in Spanish coins ) TOTAL FEES DUE or exchange Application FOR Birth Certificate Clematis Phone. Town of Birth * State File Number ( if Known ) Birth Application! 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