Form Ph 3061 PDF Details

Tax season is now in full swing and for many individuals, that means preparing and filing Form Ph 3061 - Pennsylvania Personal Income Tax Return. This form is used to report taxable income, calculate tax liability, and claim credits and deductions. If you need assistance preparing your return, the Pennsylvania Department of Revenue offers a number of resources including instructional videos, webinars, and frequently asked questions. Be sure to review all of the information available before filing to ensure that your return is accurate and complete.

QuestionAnswer
Form NameForm Ph 3061
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesverification of birth facts, mailing, TENNESSEE, 5th

Form Preview Example

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 1-6 below if you have that information. This allows the Office of Vital Records to perform a more accurate search.

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

 

PH-3061 (Rev. 5/01)

 

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:

PH-3061 (Rev. 5/01)

Version 10/02

 

RDA N/A