Securing a certified copy of a birth or death record in Texas necessitates the completion and submission of the VS 141 form, a critical document provided by the Texas Department of State Health Services. This form serves as an application for individuals seeking certified copies of birth or death records, demanding detailed information about the person on record including their full name, date of birth or death, and parental information. The application outlines associated fees for different types of certified copies, such as standard, wallet-size, and heirloom birth certificates, alongside the cost for certified death records and additional copies. With stern warnings against false statements, which could result in significant penalties including imprisonment and fines, the process emphasizes verification through a mandatory attachment of a photocopy of valid identification. Additionally, the form stipulates the confidentiality period for birth and death records, with issuance restricted to individuals capable of furnishing requisite details about the person on record, their relationship to them, and the purpose for the request. Turnaround time for receiving these vital records is projected at 6-8 weeks, a period during which applicants are urged to provide accurate identifying details to facilitate the search and avoid non-refundable fees in case of non-discovery of the records sought. This document, therefore, represents an essential tool for individuals needing official documentation for a variety of personal, legal, and administrative reasons.
| Question | Answer |
|---|---|
| Form Name | Form Vs 141 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | 1298998700kenbv brj767398 jacinto city tx vital statistics form |
TEXAS VITAL STATISTICS
TEXAS DEPARTMENT OF STATE HEALTH SERVICES
P.O. BOX 12040
AUSTIN, TEXAS
PHONE (888)
APPLICATION FOR CERTIFIED COPY OF BIRTH OR DEATH RECORD
BIRTH CERTIFICATES
# REQUESTED |
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___ CERTIFIED COPIES |
X |
$22.00 |
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X |
$22.00 |
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___ HEIRLOOM |
X |
$60.00 ____ |
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TOTAL ENCLOSED = __________
PLEASE PRINT
SEE REVERSE SIDE FOR INSTRUCTIONS
DEATH CERTIFICATES
# REQUESTED |
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___ CERTIFIED COPY |
X |
$20.00 _____ |
___ EXTRA COPIES |
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OF SAME RECORD |
X |
$3.00 _____ |
TOTAL ENCLOSED = __________
1. |
Full Name of |
First Name |
Middle Name |
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Last Name |
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Person on Record |
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2. |
Date of |
Month |
Day |
Year |
Sex |
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Birth or Death |
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Male |
Female |
3. |
Place of |
City or Town |
County |
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State |
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Birth or Death |
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4. |
Full Name of |
First Name |
Middle Name |
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Last Name |
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Father |
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5. |
Full Maiden |
First Name |
Middle Name |
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Maiden Name |
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Name of Mother |
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6. YOUR NAME: ____________________________________________________ 7. TELEPHONE #: _(____)__________________
8. MAILING ADDRESS: _______________________________________________________________________________________
STREET ADDRESS |
CITY |
STATE |
ZIP |
9.RELATIONSHIP TO PERSON NAMES IN ITEM 1: _______________________________________________________________
10.PURPOSE FOR OBTAINING THIS RECORD: __________________________________________________________________
11.ADDITIONAL IDENTIFYING FOR DEATH CERTIFICATE
SOCIAL SECURITY NUMBER OF DECEASED ____________________________
BIRTHDATE _________________________ BIRTH PLACE, ECT. ________________________________________________
Fees are subject to change without notice (call
You can expect to receive you certificate within
This fee rate(s) was set by the Texas Board of Heath and was not mandated by the Texas Legislature. Birth records are confidential for 75 years and death records for 25 years; therefore, issuance is restricted.
Administrative rules require that on restricted records, all identifying information (Item
WARNING: THE PENALTY FOR KNOWINGLY MAKING A FALSE STATEMENT IN THIS FORM CAN BE
ATTACH PHOTOCOPY OF VALID IDENTIFICATION. APPLICATION WILL NOT BE
PROCESSED WITHOUT IDENTIFICATION.
YOUR SIGNATURE |
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DATE OF APPLICATION |
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IDENTIFICATION TYPE ____________________________________________ |
NUMBER _____________________ |
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INSTRUCTIONS FOR APPLICATION FOR CERTIFIED COPY OF A BIRTH OR DEATH RECORD
Check the appropriate box either a Birth or Death record.
Indicate the number of records requested and compute the amount of money to be sent. PLEASE DO NOT SEND CASH THROUGH THE MAIL. WE SUGGEST YOU SEND WITHER A PERSONAL CHECK OR MONEY ORDER MADE PAYABLE TO: DSHS – VITAL STATISTICS.
Item 1. Name of Record:
State the FULL NAME of the person shown on the record being requested.
Item 2. Date of Event: (The date of the birth OR death.)
Give the exact date of the birth or day the person died. (If you do not know that exact date of death, then give the date the person was last known to be alive.)
Sex:
Check the appropriate box, male or female.
Item 3. Place of Event:
State the name of the city or county in which the birth or death occurred. (If you do not know the exact place of death, show the last address known when the person was alive).
Item 4. Father’s Name:
Give the full name of the father of the person shown on the record.
Item 5. Mother’s MAIDEN Name:
Give the FULL MAIDEN NAME of the mother of the person shown on the record.
Item 6. Applicant’s Name:
GIVE YOUR full name.
Item 7. Telephone Number:
Give is a telephone number with area code where you can be reached between the hours of 8 am and 5 pm, Monday through Friday.
Item 8. ADDITIONAL IDENTIFYING INFORMATION FOR DEATH CERTIFICATE:
This additional information assists our staff in positively identifying a record when exact date, places and spelling of the name (s) are not known for a death certificate:
Social security Number of the deceased
Birthdate of the deceased
Birthplace of the deceased
Any other information that would be helpful in identifying the record of an individual
Item 9. Mailing Address:
Give is your complete current mailing address.
Item 10. Relationship to person named on the record:
State how you are related to the person whose record you requesting.
Item 11. Purpose for obtaining the record:
State the reason or purpose for which you are requesting the record.
SIGN AND DATE THE APPLICATION. ENCLOSE A PHOTOCOPY OF YOUR ID WITH A PICTURE ON IT (PHOTOCOPY OF PICTURE ID). MAIL TO ADDRESS AT TOP OF APPLICATION FORM WITH THE CORRECT FEE (S).
WWW.DSHS.STATE.TX.US/VS