In the quest to secure essential documents, individuals often find themselves navigating the procedural intricacies of obtaining vital records. Within the Tennessee Department of Health, the Office of Vital Records plays a crucial role in this process, particularly through the PH1654 form, a pivotal document for those seeking certified copies of a Tennessee birth certificate. As outlined in the form, applicants are required to furnish detailed personal information, alongside a stipulated fee of $15.00 per copy, to facilitate the search and retrieval of records. Notably, the form also accommodates the acquisition of the Voluntary Acknowledgment of Paternity for an additional fee, when purchased in conjunction with the birth certificate. Key elements include the full name as it appears on the birth certificate, the specifics of any name changes not resulting from marriage, date and place of birth, and parental details. Moreover, the form underscores the legalities surrounding the submission of requests, emphasizing the illegality of submitting false statements. It has a clear stipulation regarding the archival period of records, specifying that those beyond 100 years are housed at the TN State Library and Archives. Applicants are also advised on payment methods, the necessity of a notarized application or a photocopy of a valid government-issued ID, and the procedure to follow should there be no response within 45 days. This comprehensive document exemplifies the structured approach Tennessee adopts in safeguarding and availing vital records to its citizens, ensuring a blend of accessibility and adherence to legal standards.
| Question | Answer |
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| Form Name | Tn State Form Ph1654 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | tennessee birth certificate sample, tennessee, 2019, tennessee birth certificate application pdf |
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TENNESSEE DEPARTMENT OF HEALTH |
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OFFICE OF VITAL RECORDS |
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APPLICATION FOR CERTIFIED COPY OF A TENNESSEE CERTIFICATE OF BIRTH |
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(La versión en español al reverso de la página) |
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Date: |
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Enclose $15.00 for each copy |
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Copy of Voluntary Acknowledgment of Paternity- $5.00 each copy |
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(When purchased with a certified copy of the birth certificate.) |
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Full name on birth certificate: _______________________________________________________________________________________________________
First |
Middle |
Last Name |
Has the name ever been changed other than by marriage?
Yes
No
If yes, what was original name? _____________________________________________________________________________________________________
Date of birth: |
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Sex: __________________________________________ |
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Month |
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Year |
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Place of birth: |
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City |
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Foreign Country (if Report of Foreign Birth) |
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Hospital where birth occurred: |
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Full name of father: |
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Full maiden name of mother: |
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Last name of mother at time of birth:
Next older brother or sister:Younger: ________________________________________
Signature of person making request: ______________________________________________________________________________
Relationship: ____________________________________________________________________________________
Purpose of copy:
Telephone number and email where you may be reached for additional information:
(_______)________________________________ ___________________________________@_______________________________
IT IS UNLAWFUL TO WILLFULLY AND KNOWINGLY MAKE ANY FALSE STATEMENT ON THIS APPLICATION. Records are filed in this office for the past 100 years; and over 100 years are available at the TN State Library and Archives.
A fee of $15.00 is charged for the search of the records and includes one copy of the record if located. Search fees are non- refundable if the record is not on file. All items must be completed and appropriate fees attached to process this request. Do not send cash. Send check or money order payable to: Tennessee Vital Records. In addition, unless this application is notarized, you must send a photocopy of a VALID government issued ID showing your signature. If you have not received a response within 45 days, please write or call Tennessee Vital Records at (615)
PRINT NAME AND ADDRESS BELOW FOR OUR RECORDS
Please remember to include the Fee and a Copy of your ID. (Note: The request will be returned if not included.)
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Mail Your Application To: |
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Tennessee Vital Records |
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Andrew Johnson Tower, 1st Floor |
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710 James Robertson Parkway |
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Nashville, TN 37243 |
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Zip Code |
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SW16 |