In some industries, design is everything. The way something looks can make or break a product, and companies put a lot of time and thought into making their products look as appealing as possible. In the fitness industry, form is key when it comes to getting results. However, there's another element to consider if you want to see real progress: 235. While form is important, 235 also has a major impact on your ability to get fit and stay healthy. In this blog post, we'll take a closer look at what 235 means for your workouts and how you can use it to achieve better results. Stay tuned!
| Question | Answer |
|---|---|
| Form Name | Form Vs 235 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | certif, kdhe, birth certificate application, VS-235 |
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
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NUMBER OF CERTIFICATES REQUESTED |
FEE INFORMATION ON REVERSE SIDE |
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CERTIFIED COPIES |
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TOTAL FEE |
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(SEE REVERSE SIDE) |
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NAME ON CERTIFICATE |
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FIRST |
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MIDDLE |
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LAST |
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DATE OF BIRTH |
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PRESENT AGE OF THIS PERSON |
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RACE |
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MONTH |
DAY YEAR |
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DATE OF DEATH, IF APPLICABLE |
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SEX: M |
F
PLACE OF BIRTH |
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COUNTY |
STATE (MUST BE KANSAS ) HOSPITAL |
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CITY |
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MOTHER’S NAME |
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BIRTHPLACE |
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FIRST |
MIDDLE |
MAIDEN |
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FATHER’S NAME |
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BIRTHPLACE |
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FIRST |
MIDDLE |
LAST |
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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)
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(SEE REVERSE SIDE FOR ELIGIBILITY REQUIREMENTS) |
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YOUR SIGNATURE (REQUIRED) |
TODAY’S DATE |
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KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT |
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CENTER FOR HEALTH AND ENVIRONMENTAL STATISTICS |
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MAILING ADDRESS: |
OFFICE OF VITAL STATISTICS |
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1000 SW JACKSON, SUITE 120 |
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TOPEKA, KS |
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OFFICE HOURS: 8:00 - 5:00, MONDAY – FRIDAY, PHONE (785)
PLEASE ENCLOSE A BUSINESS SIZE
FORM
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: |
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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 |
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TWO OF THE FOLLOWING: |
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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 |
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FEE INFORMATION
K.A.R.
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
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
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.