Florida Birth Certificate PDF 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 fields53
Avg. time to fill out11 min 6 sec
Other namesflorida birth certificate sample, florida birth certificate pdf, florida birth certificate application pdf, birth certificate form pdf

Form Preview Example

APPLICATION FOR A FLORIDA BIRTH RECORD

(1917 to present years available)

Florida Department of Health in Pinellas County/Office of Vital Statistics

8751 Ulmerton Rd., Ste. 1700, Largo, FL 33771 (*M-F 8-4:30 pm) (#727-507-4330 x 6316 / Fax #727-507-4335)

Read the FRONT AND BACK of this application: 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 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.

SECTION A: REGISTRANT INFORMATION

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 NAME PRIOR TO FIRST MARRIAGE

SUFFIX

MOTHER’S / PARENT’S

 

 

 

 

(If applicable)

 

NAME

 

 

 

 

 

 

 

 

 

 

 

 

FIRST

MIDDLE

LAST NAME PRIOR TO FIRST MARRIAGE

SUFFIX

FATHER'S / PARENT’S

 

 

 

 

(If applicable)

 

NAME

 

 

 

 

 

 

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 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.

SECTION B: APPLICANT (adult requesting certificate) INFORMATION

Applicant’s Name

 

FIRST, MIDDLE, LAST (INCLUDING ANY SUFFIX)

 

SIGNATURE OF APPLICANT

TYPE OR PRINT

 

 

 

 

 

 

 

 

 

HOME PHONE NUMBER

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

RELATIONSHIP TO REGISTRANT

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ALTERNATE PHONE NUMBER

CITY

 

STATE

 

ZIP CODE

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IF ATTORNEY, PROVIDE

LICENSE/ BAR NUMBER

 

NAME OF PERSON REPRESENTED

and THEIR RELATIONSHIP TO REGISTRANT

 

 

 

 

 

 

 

 

BAR/PROFESSIONAL LICENSE NO.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION C: COUNTY HEALTH DEPARTMENT FEE INFORMATION

 

 

 

 

 

 

 

(Our website http://pinellas.floridahealth.gov/certificates/index.html to order online-addl fees apply)

Cost

Quantity

Total

1st Certified Copy: (*Non-refundable fee for Birth Record search)

$13.00

1

$13.00

Additional Certified Copy: (Same day of purchase on the same person)

$8.00

 

 

Protective Plastic Sleeve:

 

 

 

$2.00

 

 

Fax or Mail Rush Orders: (Mail out within 2-3 business days by regular mail)

$5.00

Optional

 

Fed/Ex Delivery:(Mail out within 2-3 business days-no PO/APO Boxes-Continental US)

$17.00

Optional

 

Notary Services: (Same day service for amendment forms only)

$10.00

Optional

 

(Check or Money Order Payable to Vital Statistics)(Accepting Visa, Mastercard, Discover, or Amex)

TOTAL:

 

Credit Card Holder's Name

CC#

Exp

 

Sec

Date

 

Code

 

CCBilling Address/Zip CC Holder's Signature

DH 1960, 04/2016, Florida Administrative Code Rule 64V-1.0131 (Obsoletes Previous Editions)

Revised 12/1/2021

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.

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

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 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.

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.An eligibly verification will be completed before charging the nonrefundable search fee for applicants that will need to send additional forms and payment to the State Office in Jacksonville before a certificate can be released to them (Adoptions, Paternity, and Legal Name Changes).

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

COUNTY HEALTH DEPARTMENT NAME AND ADDRESS

DH 1960, 04/2016, Florida Administrative Code Rule 64V-1.0131 (Obsoletes Previous Editions)

Revised 12/1/2021

How to Edit Florida Birth Certificate Online for Free

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Enter the essential data in each one segment to complete the PDF birth certificate form

florida birth certificate application form pdf empty fields to consider

Make sure you note the demanded information in the IFATTORNEYPROVIDE, BARPROFESSIONALLICENSENO, LICENSEBARNUMBER, NAMEOFPERSONREPRESENTED, andTHEIRRELATIONSHIPTOREGISTRANT, SecCode, ExpDate, Quantity, Total, OptionalOptionalOptional, TOTAL, and Revised area.

Finishing florida birth certificate application form pdf step 2

Step 3: Click the button "Done". The PDF file is available to be transferred. It is possible to save it to your device or send it by email.

Step 4: Get no less than several copies of your document to avoid all of the possible challenges.

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