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.
Question | Answer |
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Form Name | Form Phs520F |
Form Length | 1 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 15 sec |
Other names | Louisiana, form of birth certificate, WILLFULLY, FALSE |
PHS520F(Rev. 6/00)
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________________________________________________________________________________________________ |
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NAME AT BIRTH (FIRST, MIDDLE, LAST) |
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__________________________________________________ |
___________________________________________ |
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DATE OF BIRTH |
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SEX |
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CITY OF BIRTH |
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PARISH OF BIRTH |
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FATHER’S NAME |
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________________________________________________________________________________________________ |
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MOTHER’S MAIDEN NAME"(BEFORE MARRIAGE) |
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HOW ARE YOU RELATED TO THE PERSON WHOSE RECORDS YOU ARE REQUESTING? (Check one:) |
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______ Self |
______Mother/Father |
______Child |
______Grandparent |
______Grandchild |
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______ Current Spouse |
______Sister/Brother |
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______Legal Guardian ( |
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PRINT YOUR ADDRESS: |
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Name________________________________________________________ |
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Street or |
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Route No.____________________________________________________ |
Number of |
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City |
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Copies Requested: _____________________ |
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and State_____________________________________________________ |
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Home |
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Office |
ZIP CODE |
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Total Fees Due |
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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 $10,000 OR IMPRISONMENT OF MORE THAN FIVE YEARS OR BOTH.
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Signature of Applicant________________________________________________________________ |
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*Please note: |
Birth records over !"#$% and Death records over &!"#$% are obtained by writing the Louisiana State Archives, P.O. Box |
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94125, Baton Rouge, LA 70804"9125. Please make check PAYABLE TO: Secretary of State |
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NOTES:
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Computer: |
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Certificate # |
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Referred to State |
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Vital Records: |
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Date |