florida birth certificate application form pdf

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($0.00) Tj /Tx BMC EMC EMC endstream endobj 37 0 obj <>/Subtype/Form/Type/XObject>>stream APPLICATION FOR FLORIDA BIRTH RECORD . endstream endobj startxref Florida Birth Certificate Application Request your official Florida Birth Certificate by Mail from Home. /Tx BMC Q EMC /Tx BMC %%EOF /Tx BMC Box 5135 Tampa, Florida 33675-5135 Florida Birth Record Application. /Helv 8.141 Tf �L�@E �@��@�#CP�؁�"T��@��UhY��q�/@��{+1@r;��^ 4��1�m��^5K}V�r牄��љ��#C�=E�-.skLb�d� *�j�hd0 �d( /Tx BMC C. ounty. /Tx BMC $24.00 $7.00. 1 1 33.897 11.471 re endstream endobj 1095 0 obj <>/Subtype/Form/Type/XObject>>stream Requirement for ordering: If you are an eligible applicant, complete and sign this application, state your relationship to registrant and provide a copy of valid photo identification. endstream endobj 1111 0 obj <>/Subtype/Form/Type/XObject>>stream EMC EMC Florida Department of Health - Hillsborough County Vital Statistics P.O. APPLICATION FOR A FLORIDA BIRTH RECORD (County Health Department Use Only) ... identification must be provided. EMC EMC endstream endobj 1105 0 obj <>/Subtype/Form/Type/XObject>>stream marriage certificates, birth certificates, court orders) The registrant (person named on the certificate) Spouse … EMC endstream endobj 60 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream endstream endobj 1110 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 1091 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC /Tx BMC APPLICATION FOR CERTIFIED COPY OF BIRTH/DEATH CERTIFICATE. /Tx BMC endstream endobj 1116 0 obj <>/Subtype/Form/Type/XObject>>stream EMC %PDF-1.7 %�� /Helv 8.497 Tf endstream endobj 1117 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC Palm Beach County . Has the person on … EMC 0 g EMC n endstream endobj 1113 0 obj <>/ProcSet[/PDF]>>>>stream /Tx BMC H. ealth . /Tx BMC EMC Birth Certificate Forms . �d��UY�8�=+1L�e��5�q��0\��#�: EMC h�bbd```b``��A$�mɰ,�!� &�ġ"�1Ԭ�!х$˸ /Tx BMC /Tx BMC q 7.328 3.5831 Td endstream endobj 22 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 1081 0 obj <>/Subtype/Form/Type/XObject>>stream APPLICATION FOR FLORIDA BIRTH RECORD Requirement for ordering: If applicant is self, parent, ... the Affidavit to Release a Birth Certificate must be completed by an authorized person and submitted in addition to this application form. W endstream endobj 1102 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 28 0 obj <>/Subtype/Form/Type/XObject>>stream Vital . /Helv 7.497 Tf 780 SW 24 Street, Ft. Lauderdale, FL 33315-2643 (954)-467-4 . EMC EMC /Tx BMC each. D8��Dl��@�D�ļ;L�gA�30�#��;��9�! 1st Thurs of the Month 8:00 AM -3:00 PM . /Helv 8.207 Tf 413. /Helv 8.207 Tf W n EMC ($0.00) Tj endstream endobj 65 0 obj <>stream endstream endobj 51 0 obj <>/Subtype/Form/Type/XObject>>stream ET (0) Tj /Tx BMC /Helv 8.207 Tf D. epartment of . /Tx BMC endstream endobj 55 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream EMC EMC 0 g /Tx BMC 209 0 obj <>stream endstream endobj 39 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 25 0 obj <>/Subtype/Form/Type/XObject>>stream EMC (0) Tj endstream endobj 1115 0 obj <>/Subtype/Form/Type/XObject>>stream Main Office at 477 Houston Street, Green Cove Springs. Sex *? %%EOF (0) Tj EMC endstream endobj 44 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC Acceptable forms of identification are the following: Driver’s License, State Identification Card, Passport, and/or Military Identification Card. /Tx BMC Q /Tx BMC /Tx BMC endstream endobj 1083 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC H. ealth . Acceptable forms of identification are the following: Driver’s License, State Identification Card, Passport, and/or Military Identification Card. EMC /Helv 7.912 Tf endstream endobj 1093 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC Q Expired forms of identification will not be accepted. BT endstream endobj 1094 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 43 0 obj <>/Subtype/Form/Type/XObject>>stream Number of Copies Requested: Number of Pairs Requested: Number of Copies Requested: $15.00. EMC W /Tx BMC Q EMC endstream endobj 32 0 obj <>/Subtype/Form/Type/XObject>>stream 7.897 3.4952 Td 18 0 obj <> endobj EMC 0 g endstream endobj 49 0 obj <>/Subtype/Form/Type/XObject>>stream VSA 430B 2019/07/11 OTHER SERVICES - Genealogy Certificates and/or Commemorative Certificates - B.C. endstream endobj 50 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC endstream endobj 1103 0 obj <>/Subtype/Form/Type/XObject>>stream Q BT IMPORTANT: Read the entire application form before completing. endstream endobj 61 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream (0) Tj /Tx BMC EMC D. epartment. endstream endobj 1088 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 58 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream 19.961 3.3975 Td @%hgj(H(�B3�u2h�E�=U��ֳo�]�7��%lg�G�:��t��C�ᣰ'X��]��b %��;��"3.Ї�"R�P4ģ��b(X�>TQ�o�V�&r. 1077 0 obj <> endobj endstream endobj 1122 0 obj <>/Subtype/Form/Type/XObject>>stream 0 g endstream endobj 1124 0 obj <>/Subtype/Form/Type/XObject>>stream 1 1 34.331 11.08 re /Tx BMC /Tx BMC SECTION A: REGISTRANT … 19.677 3.4757 Td APLICATION FOR A FLORIDA BIRTH CERTIFICATE For Miami-Dade VITAL RECORDS Use Only 18680 NW 67th Ave Hialeah, FL 33015 Tel.# 305-628-7227 ONLY IN PERSON 8:00AM to 4:30 PM ONLY IN PERSON 8:00AM to 4:30 PM FIRST, MIDDLE, LAST (INCLUDING ANY SUFIX) SIGNATURE OF APPLICANT Read the Front and Back of this application. Florida law restricts the issuance of birth certificates. EMC D. epartment. 1231 0 obj <>stream endstream endobj 1121 0 obj <>/Subtype/Form/Type/XObject>>stream ReQuirement for orderina: If applicant is self. endstream endobj 1126 0 obj <>stream /Tx BMC endstream endobj 46 0 obj <>/Subtype/Form/Type/XObject>>stream Download (28 KB) Locations. 0 g /Tx BMC endstream endobj 1120 0 obj <>/Subtype/Form/Type/XObject>>stream HEALTH . W 8.115 3.4952 Td EMC endstream endobj 1114 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 52 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 57 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream APPLICATION FOR AMENDMENT TO FLORIDA BIRTH RECORD . BT BT endstream endobj 31 0 obj <>/Subtype/Form/Type/XObject>>stream q B. roward . endstream endobj 56 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream /Tx BMC 0 g /Tx BMC EMC EMC Download (27 KB) pdf Florida Birth Certificate Application in Spanish. endstream endobj 38 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 1119 0 obj <>/Subtype/Form/Type/XObject>>stream 8.788 3.2806 Td /Helv 8.207 Tf 28.781 2.3984 Td /Helv 7.884 Tf B. roward . Requirements for ordering: If applicant … ET /Tx BMC endstream endobj 1123 0 obj <>/Subtype/Form/Type/XObject>>stream EMC each. endstream endobj 1086 0 obj <>/Subtype/Form/Type/XObject>>stream 0 g EMC /Tx BMC 19.793 3.5831 Td endstream endobj 1118 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC in . EMC endstream endobj 1112 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 63 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream /Tx BMC 1 1 42.3085 10.644 re F. lorida. Birth | Florida Department of Health Free www.floridahealth.gov If applicant is not one of the above, the application must be accompanied with a notarized Affidavit to Release a Birth Certificate (DH Form 1958) signed by one of the above, along with any supporting documentation and a copy of valid photo ID of both the person authorizing release and the applicant … W You must provide a current unexpired document issued to you by the Department of Homeland Security (DHS) showing your immigration status, such as Form I-551, I-94, or I-766. ($0.00) Tj endstream endobj 23 0 obj <>/Subtype/Form/Type/XObject>>stream EMC 0 g q W /Tx BMC BT /Tx BMC EMC Requirement for ordering: If applicant is self, parent, guardian, or legal representative, then the applicant must complete this application and provide photo identification. Please enter the birth information of the individual who needs the birth certificate. SUBTOTAL Mail orders add . ET endstream endobj 19 0 obj <> endobj 20 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC/ImageI]/XObject<>>>/Rotate 0/Type/Page>> endobj 21 0 obj <>/Subtype/Form/Type/XObject>>stream EMC endstream endobj 29 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC /Tx BMC 1 1 41.8781 10.991 re application for a florida death record Any person who willfully and knowingly provides any false information on a certificate, record or report required by Chapter 382, Florida Statutes, or on any application or affidavit, or who obtains confidential information from any Vital Record under false or fraudulent purposes, commits a h��[o�:��+�b��E'vZ�I�\�ٳ=ip��J"��m��R��r�Ǯz�"�EQ3C~�7䐦��PDS� I4��P�Qg0� Tc ET 0 g n endstream endobj 1090 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC /Tx BMC West Palm Beach, FL 33401 . endstream endobj 45 0 obj <>/Subtype/Form/Type/XObject>>stream your child), enter their birth information here. endstream endobj 1099 0 obj <>/Subtype/Form/Type/XObject>>stream EMC GET THE DOCUMENTS. complete this application and provide valid photo identification; if a mail request, a copy of the valid photo identification must be provided. 76 0 obj <>/Filter/FlateDecode/ID[<0D997461C2352034DC28DD58EA00746D><50549AC169AC7545AD7C8E82C6F68453>]/Index[18 192]/Info 17 0 R/Length 143/Prev 66201/Root 19 0 R/Size 210/Type/XRef/W[1 2 1]>>stream EMC BT endstream endobj 30 0 obj <>/Subtype/Form/Type/XObject>>stream Q … Hours of Operation: Florida ~- ~~ Florida Department of Health in Palm Beach County . Birth Certificate + Birth Card (sold as pair only) Death Certificate. PART 6 -FEES Includes one certified copy or no-find letter PART 5 -INFORMATION NEEDED TO FIND BIRTH RECORD BEING REQUESTED APPLICATION FOR A CERTIFIED COPY — MICHIGAN BIRTH RECORD Michigan Department of Health and Human Services PART 1 -APPLICANT’S INFORMATION PART 4 -ELIGIBILITY-Select the category that qualifies YOU to request/receive this Michigan birth … /Helv 12 Tf Q BT endstream endobj 40 0 obj <>/Subtype/Form/Type/XObject>>stream state charge per transaction (no coins) TOTAL FEES DUE . EMC BT endstream endobj 1096 0 obj <>/Subtype/Form/Type/XObject>>stream (0) Tj /Tx BMC EMC 1. W /Tx BMC EMC APPLICATION FOR FLORIDA BIRTH RECORD . endstream endobj 1092 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC 2. REVIEW YOUR ORDER . n�y b8ǔ#� TU�p4)F�P ET Acceptable forms of identification are a valid state Driver’s License, state ID Card, U.S. Passport, or Military ID Card. %PDF-1.6 %�� APPLICATION FOR FLORIDA DEATH OR FETAL DEATH RECORD of death. EMC endstream endobj 62 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream /Helv 9.5396 Tf 0 g q ET /Tx BMC D. epartment of . EMC EMC Last name * Suffix. EMC 800 Clematis Street Phone: (561)837-5847 . /Tx BMC F. lorida. APPLICATION FOR FLORIDA BIRTH RECORD For Miami Dade Coun VITAL RECORDS Use Onl aso NW 14th Street Miami, FL 33125 Tel*305-S75£030 ALK4N & ORDERS 8:00 AM to 4:00 PM HOURS: 18680 NW 67th Avenue Hialeah, Fl- 33015 WALK-IN Ot&Y 8:00 AM to 4:30 PM 18256 Homestead Avenue Miami, FL 33157 Tel." endstream endobj 36 0 obj <>/Subtype/Form/Type/XObject>>stream 0 g endstream endobj 64 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream Modified on 10 July 2019 . Q /Tx BMC EMC /Tx BMC Consular Report of Birth, Certificate of Citizenship, or Certificate of Naturalization. endstream endobj 1078 0 obj <>/Metadata 19 0 R/Pages 1075 0 R/StructTreeRoot 30 0 R/Type/Catalog/ViewerPreferences 1143 0 R>> endobj 1079 0 obj <>/MediaBox[0 0 612 792]/Parent 1075 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 1080 0 obj <>/Subtype/Form/Type/XObject>>stream q Acceptable forms of identification are the following: Driver’s License, State Identification Card, Passport, and/or Military Identification Card. 7.898 3.4952 Td EMC /Tx BMC In addition to the standard fees for certiﬁcates, the customer must also submit two (2) separate money orders or cashier's … /Tx BMC Record Information. If applicant is not one of the above, the Affidavit to Release a Birth Certificate must be completed by an authorized person and submitted in addition to this application form. q Q endstream endobj 1107 0 obj <>/Subtype/Form/Type/XObject>>stream FILL OUT FORMS. APPLICATION FOR A FLORIDA BIRTH RECORD Read the FRONT AND BACK ... Affidavit to Release a Birth Certificate must be completed by an authorized person and submitted in addition to this application form. /Helv 8.207 Tf endstream endobj 34 0 obj <>/Subtype/Form/Type/XObject>>stream h��[tG.�+3�۔�6��q!�b�c5��Hr'N]Y:�jd�$q��β�3��G��vvW{�ND�D�%��4%b�D�L��dS#%�jRb�D��^!T��J(ubh�*"��j��J��"ܛ"��L ��]#�J�t�@�LM�(� }�D�E�׈��p�E��=H'h�R �E�*ЁB��DJT��DᡠMΒ�M�4��:t��DG t�ˀ^�*N �� /Tx BMC EMC 1 1 42.7451 11.08 re (0) Tj Evidence of Immigration Status. 813-903-3370 Mailing Address. ET EMC /Tx BMC endstream endobj startxref ET EMC /Tx BMC IMPORTANT INFORMATION TO AVOID DELAY: PAGE 2 OF 2 This information is collected by the … 413. If not one of the above, you must complete this application and have a notarized Affidavit to Release A Birth Certificate (DH Form 1958, 08/2010) submitted with your application for the birth record along with a copy of the registrant's valid photo identification as well as the applicant's valid photo identification. /Tx BMC EMC n 1 1 34.768 11.08 re First name * Middle name. q EMC Birth Certificate. RECORDS ONLY To obtain an application for either of these services, visit our website or contact us by telephone. BT /Tx BMC 1 1 42.3085 11.08 re endstream endobj 1108 0 obj <>/Subtype/Form/Type/XObject>>stream EMC If you are an international student or exchange If you are applying for someone else (i.e. BT EMC EMC endstream endobj 1082 0 obj <>/Subtype/Form/Type/XObject>>stream C. ounty. ($0.00) Tj h�b```e``1``c`pLe�g@ ~��R;� EMC endstream endobj 1089 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC q endstream endobj 1098 0 obj <>/Subtype/Form/Type/XObject>>stream S�p��pgQD�hYi"$�O Z�. W 0 g 20.09 3.4952 Td @� D�%9 endstream endobj 1109 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC /Tx BMC in . endstream endobj 42 0 obj <>/Subtype/Form/Type/XObject>>stream BT /Tx BMC 3. endstream endobj 35 0 obj <>/Subtype/Form/Type/XObject>>stream EMC endstream endobj 1106 0 obj <>/Subtype/Form/Type/XObject>>stream ET APPLICATION FOR FLORIDA BIRTH RECORD . endstream endobj 27 0 obj <>/Subtype/Form/Type/XObject>>stream TYPE OR PRINT . /Tx BMC EMC Birth Certificate Forms Documents . /Tx BMC endstream endobj 33 0 obj <>/Subtype/Form/Type/XObject>>stream APPLICATION FOR A FLORIDA BIRTH RECORD Read the FRONT AND BACK of this application: ... an authorized person and submitted in addition to this application form. /Tx BMC /Tx BMC S. tatistics . If not one of the above, you must complete this application and have a notarized Affidavit to Release A Birth Certificate (DH Form 1958, 08/2010) submitted with your application for the birth record along with a copy of the registrant's valid photo identification as well as the applicant's valid photo identification. APPLICATION FOR A FLORIDA BIRTH RECORD ALTERNATE PHONE NUMBER HOME PHONE NUMBER FATHER'S / PARENT’S NAME FIRST SECTION B: APPLICANT (adult requesting certificate) INFORMATION SIGNATURE OF APPLICANT IMPORTANT INFORMATION Any person who willfully and knowingly provides any false information on a certificate, record or report required by Chapter 382, Florida Statutes, or on any application … ET EMC 1 1 85.5746 11.7011 re n W endstream endobj 1097 0 obj <>/Subtype/Form/Type/XObject>>stream Birth information of the person on record . If not one of the above, you must complete this application and have a notarized Affidavit to Release A Birth Certificate (DH Form 1958, 08/2010) submitted with your application for the birth record along with a copy of the registrant's valid photo identification as well as the applicant's valid photo identification. /Tx BMC APPLICATION FOR A FLORIDA BIRTH RECORD (County Health Department Use Only) ... the Affidavit to Release a Birth Certificate must be completed by an authorized person and submitted in addition to this application form. EMC /Tx BMC Acceptable forms of identification are the following: Driver’s License, State Identification Card, Passport, and/or Military Identification Card. ($0.00) Tj W Acceptable forms of identification are the following: Driver’s License, State Identification Card, Passport, and/or Military Identification Card. EMC EMC /Tx BMC Q EMC Proof of identity is required to prove eligibility. /Tx BMC /Tx BMC DH 1960, 04/2016, Florida Administrative Code Rule 64V-1.0131 (Obsoletes Previous Editions) SUFFIX SUFFIX SEX SUFFIX SUFFIX ((( and THEIR RELATIONSHIP TO REGISTRANT Applicant’s … County of birth * State File Number (If Known) Birth record information. S. tatistics . Name at Birth… n 18.684 3.6046 Td EMC endstream endobj 54 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream n /Tx BMC endstream endobj 1101 0 obj <>/Subtype/Form/Type/XObject>>stream pdf Florida Birth Certificate Application. Birth/Death Certificates 813-307-8002 DLCHD29WebsiteDistribution@flhealth.gov Fax. Acceptable forms of valid ID are: driver's license, state identif SECTION A - INFORMATION ON TYPE OF RECORD AND DECEDENT PLEASE CHECK APPROPRIATE BOX: DEATH FETAL DEATH NAME OF DECEDENT FIRST MIDDLE LAST SUFFIX ALIAS NAME(IF APPLICABLE) IF MARRIED AND … APPLICATION FOR A FLORIDA BIRTH RECORD Read the FRONT AND BACK of this application: ... you must complete this application and have a notarized Affidavit to Release A Birth Certificate (DH Form 1958, 08/2010) submitted with your application for the birth record along with a copy of the registrant's valid photo identification as well as the applicant's valid photo identification. 0 g endstream endobj 1084 0 obj <>/Subtype/Form/Type/XObject>>stream Office of Vital Statistics 8:00AM-4:30PM. Box 648 … SECTION A: REGISTRANT INFORMATION FIRST MIDDLE LAST P.O. 1 1 42.3091 11.471 re /Tx BMC Florida Birth Certificate replacement Application Form. endstream endobj 26 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC Vital . ɸ�"��$�͙�� l#�(9JB�� 0 �j2� /Tx BMC EMC /Tx BMC EMC /Tx BMC the Affidavit to Release a Birth Certificate must be completed by an authorized person and submitted in addition to this application form. ET endstream endobj 1104 0 obj <>/Subtype/Form/Type/XObject>>stream $0.50 . endstream endobj 1085 0 obj <>/Subtype/Form/Type/XObject>>stream 1 1 34.334 11.08 re Florida Birth Record Application (Creole) Florida Birth Record Application (E spañol) Florida Birth … EMC n City / town of birth * Date of Birth * Name of hospital. q EMC endstream endobj 41 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC ��L � h˻v mĖ`�e��9 If not one of the above, you must complete this application and have a notarized Affidavit to Release A Birth Certificate (DH Form 1958, 08/2010) submitted with your application for the birth record along with a copy of the registrant's valid photo identification as well as the applicant's valid photo identification. EMC /Tx BMC EMC endstream endobj 1100 0 obj <>/Subtype/Form/Type/XObject>>stream EMC /Tx BMC endstream endobj 59 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream 19.871 3.4952 Td 305-278-1046 WALK-'N ONLY 8:00 AM to 4:30 PM t must ant se .