Form Phs520F PDF Details

Understanding and correctly filling out the PHS520F form is vital for anyone seeking to request official records, especially within specific jurisdictions where this form is recognized and required. This form, updated in June 2000, plays a crucial role in the procurement of vital records, such as birth and death certificates, by stipulating a clear path for identity validation and relationship confirmation between the applicant and the subject of the records. It begins by collecting the applicant's personal information, like name at birth and date of birth, including details about the city and parish of birth, as well as the names of the applicant's parents. Importantly, it mandates the applicant to state their relationship to the person whose records are being requested, offering multiple choices including self, mother/father, child, grandparent, grandchild, current spouse, sister/brother, or legal guardian. Furthermore, the form requires comprehensive contact details from the applicant along with the necessary fees and the declaration of the number of copies requested. A section underlining the legal implications for providing false information is also included to emphasize the seriousness of the application, warning of fines or imprisonment for fraudulent claims. It makes a note that older birth and death records must be obtained through the Louisiana State Archives, providing specific instructions for this process. This form not only serves as a request document but also as a legal affidavit, highlighting the responsibility of the applicant to provide accurate and honest information.

QuestionAnswer
Form NameForm Phs520F
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesLouisiana, form of birth certificate, WILLFULLY, FALSE

Form Preview Example

PHS520F(Rev. 6/00)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

________________________________________________________________________________________________

NAME AT BIRTH (FIRST, MIDDLE, LAST)

 

 

 

__________________________________________________

___________________________________________

DATE OF BIRTH

 

 

SEX

 

 

________________________________________________________________________________________________

CITY OF BIRTH

 

 

PARISH OF BIRTH

 

________________________________________________________________________________________________

FATHER’S NAME

 

 

 

 

 

________________________________________________________________________________________________

MOTHER’S MAIDEN NAME"(BEFORE MARRIAGE)

 

 

 

HOW ARE YOU RELATED TO THE PERSON WHOSE RECORDS YOU ARE REQUESTING? (Check one:)

______ Self

______Mother/Father

______Child

______Grandparent

______Grandchild

______ Current Spouse

______Sister/Brother

 

______Legal Guardian (

PRINT YOUR ADDRESS:

 

 

 

 

 

Name________________________________________________________

 

Street or

 

 

 

 

 

 

Route No.____________________________________________________

Number of

 

City

 

 

 

 

Copies Requested: _____________________

and State_____________________________________________________

 

 

Home

 

Office

ZIP CODE

 

Total Fees Due

$____________________

Phone No.___________________ Phone No.___________________

I AM AWARE THAT ANY PERSON WHO WILLFULLY AND KNOWINGLY MAKES ANY FALSE STATEMENT IN AN APPLICATION FOR A CERTIFIED COPY OF A VITAL RECORD IS SUBJECT UPON CONVICTION TO A FINE OF NOT MORE THAN $10,000 OR IMPRISONMENT OF MORE THAN FIVE YEARS OR BOTH.

 

Signature of Applicant________________________________________________________________

 

 

*Please note:

Birth records over !"#$% and Death records over &!"#$% are obtained by writing the Louisiana State Archives, P.O. Box

 

94125, Baton Rouge, LA 70804"9125. Please make check PAYABLE TO: Secretary of State

 

 

''''''''''''''''''''''''''''

NOTES:

((

 

Computer:

_______________ ___________

Certificate #

_____________________________

Referred to State

 

Vital Records:

_____________________________

 

Date