In the realm of official documentation and record-keeping, vital records play an instrumental role in affirming personal identities and facilitating a myriad of bureaucratic processes, from obtaining a passport to enrolling in school. Central to the portfolio of essential documents is the application known as the PH-3061 form, an artifact of the Tennessee Department of Health, Office of Vital Records. This form serves as a request for the verification of birth facts, a procedure that underscores the importance of accurate birth records for individuals and agencies alike. Accompanied by a nominal fee, this application necessitates the provision of detailed information regarding the individual whose birth record is under scrutiny — ranging from the full name at birth to the specifics of the birth location and parental details. Not merely a rudimentary request, the form encapsulates vital statistics and is a testament to the stringent documentation standards upheld by the Office of Vital Records. Crucially, the PH-3061 form is distinguished from a certified birth certificate. Instead, it functions as a verification tool that confirms birth facts as recorded, highlighting its non-utility as a form of identification but underscoring its significance in validating the existence of vital birth records. Such measures ensure the maintenance of accurate, accessible records, essential for both the state and its citizens in navigating the formalities of life's various stages.
| Question | Answer |
|---|---|
| Form Name | Form Ph 3061 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | verification of birth facts, mailing, TENNESSEE, 5th |
TENNESSEE DEPARTMENT OF HEALTH
OFFICE OF VITAL RECORDS
APPLICATION FOR VERIFICATION OF BIRTH FACTS
THIS APPLICATION MUST BE ACCOMPANIED BY A CHECK OR MONEY ORDER MADE
PAYABLE TO TENNESSEE VITAL RECORDS FOR $12.00.
Name and mailing address where verification is to be sent:
|
Name of Individual or Requesting Agency |
Date |
||
|
|
|
( |
) |
|
Street Address |
Telephone No. |
||
|
|
|
||
City |
State |
Zip |
||
In order for the Office of Vital Records’ staff to search the files of birth records, please provide the following information from the record you are requesting:
____________
Year of Birth
_____________________ |
|
__________________________ |
___________________________ |
Name of Child at Birth |
or |
Name of Father (if named) |
or Name of Mother (if no father named) |
Also complete items
A fee of $12.00 is charged for the search of the year and the name entered above. This fee is charged even if no record is found. If you want to search more than one year of records, please enclose $12.00 for each additional year.
1. |
Full name at Birth: _____________________________________________________________ |
||||
|
|
|
First |
Middle |
Last |
2. |
Date of Birth: _______________________________________ |
|
|||
|
Month |
|
Day |
Year |
|
3. |
Gender: (Circle One) |
Male |
Female |
|
|
4.City or County of Birth: __________________________________________________________
5.Mother’s Full Maiden Name: ______________________________________________________
FirstMiddleLast
6. Father’s Full Name: _____________________________________________________________
First |
Middle |
Last |
MAIL THIS APPLICATION TO: |
|
|
Tennessee Department of Health |
|
|
OFFICE OF VITAL RECORDS |
|
|
|
Central Services Building |
|
|
421 5th Avenue North, 1st floor |
|
|
Nashville, TN 37247 |
|
|
Version 10/02 |
|
|
|
RDA N/A |
Do not write below. The staff at the Office of Vital Records will enter information.
This form is not a birth certificate. The information is transcribed from the original document.
This cannot be used as a form of identification.
1.Child’s Full Name at Birth:
2.Date of Birth:
3.Sex:
4.Time of Birth:
5.Place of Birth:
6.Facility or Hospital:
7.Mother’s Full Maiden Name:
8.Mother's Age or Date of Birth:
9.Mother’s State of Birth:
10.Mother’s Occupation:
11.Father's Full Name:
12.Father’s Age or Date of Birth:
13.Father’s State of Birth:
14.Father’s Occupation:
15.Mailing Address at Birth:
16.Attendant at Birth:
17.Attendant’s Address:
18.Date Certificate Filed:
Other Information:
We were unable to locate a certificate with information given.
Verified By:
Title:
Date Verified:
Version 10/02 |
|
|
RDA N/A |