Form Vs 235 PDF Details

Obtaining a certified copy of a Kansas birth certificate requires navigating the specific demands outlined in the VS 235 form, a crucial document for anyone in need of this vital record. Since July 1, 1911, the Kansas Department of Health and Environment has maintained these records, ensuring secure and confidential access to birth certificates. The application process includes a fee structure—$12.00 for the first certified copy or wallet size, with an additional $7.00 for each subsequent copy of the same record. Applicants are required to provide comprehensive personal details, including names, birth date, and more, ensuring the information pertains directly to the individual on the certificate. Security is paramount; hence, proof of identification through government-issued photo IDs or alternative documents is mandatory to combat identity theft and fraudulent activities. The form also addresses specifics like adoption, eligibility criteria, and the legal ramifications of falsifying this document. With concise instructions and clear stipulations, the VS 235 form stands as a gateway for individuals to officially affirm their identity, lineage, and nationality, serving roles beyond mere record-keeping to impact various aspects of personal and legal significance.

QuestionAnswer
Form NameForm Vs 235
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namescertif, kdhe, birth certificate application, VS-235

Form Preview Example

APPLICATION FOR CERTIFIED COPY OF KANSAS BIRTH CERTIFICATE

BIRTH CERTIFICATES ARE ON FILE FROM JULY 1, 1911 TO PRESENT

(PLEASE PRINT)

$12.00 FOR ONE CERTIFIED COPY OR WALLET SIZE AND $7.00 FOR EACH ADDITIONAL CERTIFIED COPY OR CARD OF THE SAME RECORD

 

NUMBER OF CERTIFICATES REQUESTED

FEE INFORMATION ON REVERSE SIDE

 

 

CERTIFIED COPIES

 

WALLET-SIZE

 

 

TOTAL FEE

 

 

 

 

 

 

 

 

 

 

(SEE REVERSE SIDE)

 

 

 

NAME ON CERTIFICATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FIRST

 

MIDDLE

 

 

LAST

DATE OF BIRTH

 

-

-

 

 

PRESENT AGE OF THIS PERSON

 

RACE

 

 

 

MONTH

DAY YEAR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE OF DEATH, IF APPLICABLE

 

SEX: M

F

PLACE OF BIRTH

 

 

 

 

 

 

COUNTY

STATE (MUST BE KANSAS ) HOSPITAL

 

 

CITY

MOTHER’S NAME

 

 

 

BIRTHPLACE

 

 

 

FIRST

MIDDLE

MAIDEN

FATHER’S NAME

 

 

BIRTHPLACE

 

 

FIRST

MIDDLE

LAST

COMPLETE ONLY IF PERSON NAMED ON CERTIFICATE HAS BEEN ADOPTED (SEE REVERSE SIDE)

ADOPTED? YES

NO

ORIGINAL NAME, IF KNOWN

Is request for record before adoption? YES

NO

YOU MUST INCLUDE A COPY OF PHOTO ID WITH THISFORM

OR TWO ALTERNATIVE DOCUMENTS( SEE REVERSE SIDE FOR LIST)

YOUR NAME (PLEASE PRINT)

YOUR MAILING ADDRESS

CITYSTATEZIP CODE REASON FOR REQUEST (PLEASE BE SPECIFIC)

(We ask this so that we can provide appropriate service for your needs)

YOUR DAYTIME TELEPHONE NUMBER

YOUR RELATIONSHIP TO PERSON NAMED ON CERTIFICATE (REQUIRED)

 

 

 

(SEE REVERSE SIDE FOR ELIGIBILITY REQUIREMENTS)

YOUR SIGNATURE (REQUIRED)

TODAY’S DATE

 

 

 

 

 

 

KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT

 

CENTER FOR HEALTH AND ENVIRONMENTAL STATISTICS

MAILING ADDRESS:

OFFICE OF VITAL STATISTICS

 

1000 SW JACKSON, SUITE 120

 

TOPEKA, KS

66612-2221

 

 

WALK-IN CUSTOMER SERVICE HOURS: 9:00 - 4:00, MONDAY - FRIDAY

OFFICE HOURS: 8:00 - 5:00, MONDAY – FRIDAY, PHONE (785) 296-1400

PLEASE ENCLOSE A BUSINESS SIZE SELF-ADDRESSED STAMPED ENVELOPE.

FORM VS-235 5/03

IDENTIFICATION

ID IS REQUIRED OF PERSON COMPLETING FORM Due to identity theft and other fraudulent use of vital records, acceptable ID is limited. DO NOT send original ID with application

YOU MUST PROVIDE A PHOTOCOPY OF A GOVERNMENT (STATE OR FEDERAL) ISSUED PHOTO ID. THIS CAN BE ISSUED BY THE U.S. OR OTHER COUNTRY OF RESIDENCE.

ACCEPTABLE IDENTIFICATIONS INCLUDES:

 

Photocopy of Driver’s License

Photocopy of Passport or Visa

Photocopy of State ID Card

Photocopy of Military ID

IF YOU DO NOT HAVE A GOVERNMENT ISSUED PHOTO ID, YOU MUST SEND PHOTOCOPIES OF ANY

TWO OF THE FOLLOWING:

 

SocialSecurity Number

Utility Bill With Current Address

Bank Statement With Current Address

Pay Stub (must include your name, social security

Car Registration or Title With Current

number plus name and address of business)

Address

 

FEE INFORMATION

K.A.R. 28-17-6 requires the following fee(s).

The correct fee must be submitted with the request. The fee for certified copies of birth certificates is $12.00 for one certified copy or wallet size (see information on cards below) and $7.00 for each additional certified copy or card of the same record ordered at the same time. This fee allows a 5-year search of the records, including the year indicated plus two years before and two years after, or you may indicate the consecutive 5-year period you want searched. You may specify more than one 5-year span, but each search cost $12.00

IF THE CERTIFICATE IS NOT LOCATED, A $12.00 FEE MUST BE RETAINED FOR THE RECORD SEARCH.

Make checks or money orders payable to KANSAS VITAL STATISTICS. For your protection, do not send cash.

Fees expire 12 months from the date of the request.

MULTIPLE REQUESTS FOR DIFFERENT RECORDS MAY BE HANDLED AND MAILED SEPARATELY.

WALLET SIZE CARDS

Wallet size cards may not be acceptable identification for passports, travel, social security, school enrollment or driver’s license.

NOTE: The wallet size card does not contain parental information or an embossed seal (contains ink seal only).

ELIGIBILITY

By state law, vital records filed with this office are not open for public inspection and the requestor must meet eligibility requirements -- must be named on the record, an immediate family member, or someone who can provide legal proof the record is necessary for the determination of personal or property rights. [K.S.A. 65-2422d]

If legal guardianship has been established through the courts, please provide copy of guardianship papers.

ADOPTION

When an adoption has occurred, the biological family may not have a legal right to the adoptee’s record nor may the adoptee have a legal right to the biological family’s records.

WEBSITE

For additional information, please access the web site at: http://www.kdhe.state.ks.us/vital

WARNING: COPYING OR ALTERING PROHIBITED

Except as authorized by the Uniform Vital Statistics Act, no person shall prepare or issue any certificate (vital record) which purports to be an original, certified copy or copy of a certificate [K.S.A. 65-2422d.(g)]. Any person who willfully makes or alters any certificate or certified copy, except as authorized by the Uniform Vital Statistics Act, shall be fined or imprisoned, or both. [K.S.A. 65-2434.(1)].