How To Fill A Birth Certificate Form Details

A Florida birth certificate is an important document that proves the birth of a person. This document is used for many purposes, including obtaining a passport, registering for school, and applying for a driver's license or state identification card. In order to obtain a Florida birth certificate, you must provide certain information and complete the necessary application. The process of obtaining a birth certificate can be confusing, so it is important to know what is required in order to receive your certificate. Here are some tips on how to get a Florida birth certificate.

You will discover information regarding the type of form you want to fill out in the table. It can tell you how long it will take to fill out florida birth certificate, what fields you will have to fill in and several further specific facts.

QuestionAnswer
Form NameFlorida Birth Certificate
Form Length2 pages
Fillable?Yes
Fillable fields35
Avg. time to fill out7 min 30 sec
Other namesfl birth certificate form, florida birth certificate template, certificate of live birth florida, florida birth certificate application pdf

Form Preview Example

APPLICATION FOR FLORIDA BIRTH RECORD

Hours of Operation:

Florida Department of Health in Palm Beach County

Monday-Friday

Office of Vital Statistics

8:00 AM - 4:30 PM

800 Clematis Street

Phone: (561)837-5847

West Palm Beach, FL 33401

1st Thurs of the Month 8:00 AM - 3:00 PM

Requirement for ordering: If applicant is self, parent, guardian, or legal representative, then the applicant must complete this application and provide valid photo identification, if a mail request, a copy of the valid photo identification front and back must be provided. 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. Acceptable forms of identification are the following: Driver’s License, State Identification Card, Passport, and/or Military Identification Card.

CHILD’S FULL NAME AS

 

FIRST

 

MIDDLE

 

LAST

 

SUFFIX

 

 

 

 

 

 

 

 

SHOWN ON BIRTH RECORD

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IF NAME WAS CHANGED

 

FIRST

 

MIDDLE

 

LAST

 

SUFFIX

SINCE BIRTH, INDICATE NEW

 

 

 

 

 

 

 

 

NAME

 

 

 

 

 

 

 

 

 

MONTH

DAY

YEAR (4-DIGIT)

STATE FILE NUMBER (If known)

 

SEX

DATE OF BIRTH

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HOSPITAL

 

CITY OR TOWN

 

COUNTY

PLACE OF BIRTH

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FIRST

 

MIDDLE

 

LAST

 

SUFFIX

MOTHER’S MAIDEN NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FIRST

 

MIDDLE

 

LAST

 

SUFFIX

FATHER’S NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

APPLICANT (adult requesting certificate) 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 or affidavit, or who obtains confidential information from any Vital Record under false or fraudulent purposes, commits a felony of the third degree, punishable as provided in Chapter 775, Florida Statutes.

 

Applicant’s Name

 

FIRST

 

MIDDLE

 

LAST (INCLUDING ANY SUFFIX)

 

 

 

 

 

 

 

 

 

 

 

TYPE OR PRINT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MAILING ADDRESS (INCLUDE APT. NO., IF APPLICABLE)

 

 

CITY

 

STATE

ZIP CODE

 

 

 

 

 

 

 

 

 

HOME PHONE NUMBER

RELATIONSHIP TO REGISTRANT

 

SIGNATURE OF APPLICANT

(

)

 

 

 

 

 

 

 

 

 

WORK PHONE NUMBER

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IF ATTORNEY, PROVIDE BAR/PROFESSIONAL

IF ATTORNEY , PROVIDE NAME OF PERSON YOU REPRESENT AND THEIR RELATIONSHIP TO REGISTRANT

LICENSE NO.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

One certified copy is $15.00

 

 

 

 

 

 

=$15.00

 

Additional copies are $10.00 each, when ordered with this request

$10.00

x________

=$______

Plastic Sleeve

 

 

 

 

$3.00

x________

=$______

Total

 

 

 

 

 

 

=$______

 

 

 

 

 

 

 

 

 

 

ID TYPE

 

 

 

 

 

 

 

 

 

 

 

Mail in birth application: Please send check or money order payable to:

 

 

ID #

 

 

 

Florida Department of Health, Palm Beach County

 

 

Mail in request must include a copy of your photo identification front and back with completed application.

 

 

 

 

 

 

 

 

 

 

 

 

OFFICIAL USE ONLY - To be completed by Florida Department of Health in Palm Beach County staff.

Safety Paper Number

 

 

 

 

Amount Paid: $_____

 

 

BEGINNING

ENDING

 

METHOD OF PAYMENT

RECEIVED BY:________

 

 

 

 

 

CASH___

 

 

CHECK#_____

 

 

 

 

 

 

 

VOIDED BEGINNING

ENDING

 

VISA___

MASTERCARD___

 

 

 

 

 

 

 

AMEX___

DISCOVER___

MONEY ORDER__

 

 

 

 

 

 

 

 

 

 

 

*PALM BEACH COUNTY TAX COLLECTOR

 

 

 

 

 

 

 

*An additional $6.25 surcharge may be added to the fee charged by the FDOH-

 

SURCHARGE:

 

 

Palm Beach County Vital Statistics office. The addition of this surcharge may or may

 

TOTAL:

 

 

 

 

 

not be assessed.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DH 1960, 06/13 Obsoletes Previous Editions

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 following 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:

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

2.Parent(s) listed on the Birth Record

3.Legal guardian (must provide guardianship papers)

4.Legal representative of one of the above persons

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

In 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.

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 front and back 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 Form 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.

STATES AGENCIES:

•Must have an Active Case

•Provide request on your department's letterhead or provide DCF Letter of Agreetment •Provide Agency Identification Card

IF APPLYING BY MAIL SEND REQUEST TO: VITAL STATISTICS

P.O. BOX 29

WEST PALM BEACH, FLORIDA 33402

*Check or Money Order payable to FLORIDA DEPARTMENT OF HEALTH, PALM BEACH COUNTYin U.S. Dollars.

*DO NOT SEND CASH

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:

BUREAU OF VITAL STATISTICS

ATTN: Records Amendment Section

P.O. BOX 210

Jacksonville, FL 32231-0042

PLEASE VISIT THE BUREAU OF VITAL STATISTICS WEBSITE

http://www.doh.state.fl.us/Planning_eval/Vital_Statistics/

How to Edit Florida Birth Certificate

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