Blank Florida Birth Certificate PDF Form

Blank Florida Birth Certificate PDF Form

The Florida Birth Certificate form is an official document used to request a certified copy of a birth record from the Florida Department of Health. This form is essential for individuals seeking to obtain their own birth certificate or that of a child, parent, or legal representative. To begin the process, fill out the application by clicking the button below.

The Florida Birth Certificate form is an essential document for individuals seeking to obtain a certified copy of a birth record in Florida. This application, managed by the Florida Department of Health in Pinellas County, is available for records dating from 1917 to the present. It requires specific information about the registrant, including the child's full name, date of birth, and parents' names. Applicants must also provide valid photo identification, which can include a driver's license, state ID, passport, or military ID. If the applicant is not the registrant, additional documentation such as an Affidavit to Release a Birth Certificate is necessary. The form outlines the fees associated with obtaining copies, including costs for certified copies and optional services like rush orders and notary services. Importantly, the application specifies eligibility criteria, ensuring that only authorized individuals can request a birth certificate. This includes the registrant, parents, legal guardians, and legal representatives. It is crucial to follow the instructions carefully to avoid delays or complications in the application process.

Document Sample

APPLICATION FOR A FLORIDA BIRTH RECORD

(1917 to present years available)

Florida Department of Health in Pinellas County/Office of Vital Statistics

8751 Ulmerton Rd., Ste. 1700, Largo, FL 33771 (*M-F 8-4:30 pm) (#727-507-4330 x 6316 / Fax #727-507-4335)

Read the FRONT AND BACK of this application: Requirement for ordering: If applicant is self, parent, guardian, or legal representative, then the applicant must complete this application and provide valid photo identification, if a mail request, a copy of the valid photo identification must be provided. 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. Acceptable forms of identification are the following: Driver’s License, State Identification Card, Passport, and/or Military Identification Card.

SECTION A: REGISTRANT INFORMATION

CHILD’S FULL NAME AS

FIRST

MIDDLE

 

 

LAST

SUFFIX

SHOWN ON BIRTH

 

 

 

 

 

 

RECORD

 

 

 

 

 

 

IF NAME WAS CHANGED

FIRST

MIDDLE

 

 

LAST

SUFFIX

SINCE BIRTH, INDICATE

 

 

 

 

 

 

NEW NAME

 

 

 

 

 

 

MONTH

DAY

YEAR (4 DIGIT)

 

STATE FILE NUMBER (If known)

SEX

DATE OF BIRTH

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HOSPITAL

CITY OR TOWN

 

 

COUNTY

 

PLACE OF BIRTH

 

 

 

 

 

 

 

 

 

 

 

 

 

FIRST

MIDDLE

LAST NAME PRIOR TO FIRST MARRIAGE

SUFFIX

MOTHER’S / PARENT’S

 

 

 

 

(If applicable)

 

NAME

 

 

 

 

 

 

 

 

 

 

 

 

FIRST

MIDDLE

LAST NAME PRIOR TO FIRST MARRIAGE

SUFFIX

FATHER'S / PARENT’S

 

 

 

 

(If applicable)

 

NAME

 

 

 

 

 

 

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 or affidavit, or who obtains confidential information from any Vital Record under false or fraudulent

purposes, commits a felony of the third degree, punishable as provided in Chapter 775, Florida Statutes.

SECTION B: APPLICANT (adult requesting certificate) INFORMATION

Applicant’s Name

 

FIRST, MIDDLE, LAST (INCLUDING ANY SUFFIX)

 

SIGNATURE OF APPLICANT

TYPE OR PRINT

 

 

 

 

 

 

 

 

 

HOME PHONE NUMBER

MAILING ADDRESS (INCLUDE APT. NO., IF APPLICABLE)

RELATIONSHIP TO REGISTRANT

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ALTERNATE PHONE NUMBER

CITY

 

STATE

 

ZIP CODE

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IF ATTORNEY, PROVIDE

LICENSE/ BAR NUMBER

 

NAME OF PERSON REPRESENTED

and THEIR RELATIONSHIP TO REGISTRANT

 

 

 

 

 

 

 

 

BAR/PROFESSIONAL LICENSE NO.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION C: COUNTY HEALTH DEPARTMENT FEE INFORMATION

 

 

 

 

 

 

 

(Our website http://pinellas.floridahealth.gov/certificates/index.html to order online-addl fees apply)

Cost

Quantity

Total

1st Certified Copy: (*Non-refundable fee for Birth Record search)

$13.00

1

$13.00

Additional Certified Copy: (Same day of purchase on the same person)

$8.00

 

 

Protective Plastic Sleeve:

 

 

 

$2.00

 

 

Fax or Mail Rush Orders: (Mail out within 2-3 business days by regular mail)

$5.00

Optional

 

Fed/Ex Delivery:(Mail out within 2-3 business days-no PO/APO Boxes-Continental US)

$17.00

Optional

 

Notary Services: (Same day service for amendment forms only)

$10.00

Optional

 

(Check or Money Order Payable to Vital Statistics)(Accepting Visa, Mastercard, Discover, or Amex)

TOTAL:

 

Credit Card Holder's Name

CC#

Exp

 

Sec

Date

 

Code

 

CCBilling Address/Zip CC Holder's Signature

DH 1960, 04/2016, Florida Administrative Code Rule 64V-1.0131 (Obsoletes Previous Editions)

Revised 12/1/2021

INFORMATION AND INSTRUCTIONS FOR BIRTH RECORD APPLICATION

COMPUTER CERTIFICATION: computer certifications are accepted by all state and federal agencies and used for any type of travel.

A computer certification has two different formats:

1.A certification of a registered birth (2004 to present), supplies the following facts of birth: Child's Name, Date of Birth, Sex, Time, Weight, Place of Birth (City, County and Location) and Parents' Information.

2.A certification of a registered birth (1930 to 2003), supplies the following facts of birth: Child's Name, Date of Birth, Sex, County of Birth and Parents' Name.

AVAILABILITY: Birth registration was not required by state law until 1917, but there are some records on file dating back to 1865.

ELIGIBILITY: Birth certificates can be issued only to:

1.Registrant (the child named on the record) if of legal age (18)

2.Parent(s) listed on the Birth Record

3.Legal guardian (must provide guardianship papers)

4.Legal representative of one of the above persons

5.Other person(s) by court order (must provide recorded or certified copy of court order)

In the case of a deceased registrant, upon receipt of the death certificate of the decedent, a certification of the birth certificate can be issued to the spouse, child, grandchild, sibling, if of legal age, or to the legal representative of any of these persons as well as to the parent.

Any person of legal age may be issued a certified copy of a birth record (except for those birth records under seal) for a birth event that occurred over 100 years ago.

BIRTH RECORDS UNDER SEAL: Birth records under seal by reason of adoption, paternity determination or court order cannot be ordered in the usual manner. For a record under seal, write to:

BUREAU OF VITAL STATISTICS

ATTN: Records Amendment Section

P.O. BOX 210

Jacksonville, FL 32231-0042

REQUIREMENT FOR ORDERING: If applicant is self, parent, legal guardian or legal representative, the applicant must provide a completed application along with valid photo identification, if a mail request, a copy of the valid photo identification must be provided. If legal guardian, a copy of the appointment orders must be included with the request. If legal representative, the attorney bar number, and a notation of whom the attorney represents and that person's relationship to the registrant must be included with your request. If you are an agent of local, state or federal agency requesting a record, indicate in the space provided for “relationship” the name of the agency. Acceptable forms of identification are the following: Driver’s License, State Identification Card, Passport and/or Military Identification Card.

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.

RELATIONSHIP TO REGISTRANT: A person ordering his or her own certificate should enter "SELF" in this space. Also, explain if name has been changed; married name, name changed legally (when and where), etc. Others must identify themselves clearly as eligible (see ELIGIBILITY above).

*NONREFUNDABLE: Vital record fees are nonrefundable.An eligibly verification will be completed before charging the nonrefundable search fee for applicants that will need to send additional forms and payment to the State Office in Jacksonville before a certificate can be released to them (Adoptions, Paternity, and Legal Name Changes).

APPLICANT’S SIGNATURE: Is required, as well as his/her printed name, residence address and telephone number.

COUNTY HEALTH DEPARTMENT NAME AND ADDRESS

DH 1960, 04/2016, Florida Administrative Code Rule 64V-1.0131 (Obsoletes Previous Editions)

Revised 12/1/2021

File Specifics

Fact Name Details
Application Availability The Florida Birth Certificate form is available for records from 1917 to the present.
Identification Requirements Applicants must provide valid photo identification. Acceptable forms include a Driver’s License, State ID, Passport, or Military ID.
Eligibility to Request Only certain individuals can request a birth certificate, including the registrant, parents, legal guardians, and legal representatives.
Nonrefundable Fees All fees for vital records are nonrefundable. The first certified copy costs $13.00.
Governing Law This form is governed by Chapter 382 of the Florida Statutes and Florida Administrative Code Rule 64V-1.0131.

How to Use Florida Birth Certificate

Filling out the Florida Birth Certificate form is straightforward. After completing the form, you will need to submit it along with any required identification and payment. Ensure that all information is accurate to avoid delays in processing.

  1. Obtain the Florida Birth Certificate form from the Florida Department of Health in Pinellas County or their website.
  2. Read both the front and back of the application carefully for requirements and instructions.
  3. In SECTION A, fill in the registrant's information:
    • Enter the child's full name as it appears on the birth record.
    • If the name has changed since birth, provide the new name.
    • Fill in the date of birth, including month, day, and year.
    • Provide the sex of the child.
    • Indicate the hospital, city or town, and county of birth.
    • Include the mother's and father's names prior to their first marriage, if applicable.
  4. In SECTION B, provide the applicant's information:
    • Write the applicant’s full name, including any suffix.
    • Sign the application.
    • Type or print the home phone number and mailing address.
    • State the relationship to the registrant.
    • Include an alternate phone number, if available.
    • If applicable, provide the attorney's license or bar number and the name of the person represented.
  5. In SECTION C, fill in the fee information:
    • Indicate the quantity of certified copies you are requesting.
    • Calculate the total fee based on the number of copies and any additional services selected.
    • Provide credit card information if paying by card, or indicate if paying by check or money order.
  6. Attach a valid photo identification, such as a driver’s license or passport, to the application.
  7. If mailing the application, make a copy of the identification to include with the application.
  8. Submit the completed form along with payment and identification to the address provided on the form.

Your Questions, Answered

What information do I need to provide to apply for a Florida birth certificate?

To apply for a Florida birth certificate, you must fill out the application form with detailed information about the registrant (the person whose birth certificate you are requesting). This includes:

  • Child’s full name as it appears on the birth record
  • Date of birth
  • Place of birth (hospital, city, county)
  • Parents' names (including any names prior to marriage)

Additionally, you must provide valid photo identification. Acceptable forms include a driver's license, state ID, passport, or military ID. If you are applying by mail, a copy of your ID is required.

Who is eligible to request a birth certificate?

Eligibility to request a birth certificate is limited to specific individuals. You can obtain a copy if you are:

  1. The registrant (the person named on the record) if they are 18 years or older.
  2. A parent listed on the birth record.
  3. A legal guardian (with guardianship papers).
  4. A legal representative of one of the above persons.
  5. Any other person with a court order (must provide a certified copy).

In cases where the registrant is deceased, immediate family members such as a spouse, child, or sibling can request the certificate with a death certificate.

What are the fees associated with obtaining a birth certificate?

The fees for obtaining a Florida birth certificate are as follows:

  • First certified copy: $13.00
  • Additional certified copies (same person, same day): $8.00 each
  • Protective plastic sleeve: $2.00
  • Fax or mail rush orders: $5.00
  • Optional FedEx delivery: $17.00
  • Optional notary services (for amendment forms only): $10.00

Keep in mind that these fees are nonrefundable, so ensure you meet eligibility requirements before applying.

What should I do if the birth record is under seal?

Records that are sealed due to adoption, paternity determination, or court order cannot be requested in the usual manner. If you need a record that is under seal, you must write to the Bureau of Vital Statistics. The address is:

Bureau of Vital Statistics
ATTN: Records Amendment Section
P.O. BOX 210
Jacksonville, FL 32231-0042

Include all necessary information and documentation with your request.

Can I order a birth certificate online?

Yes, you can order a Florida birth certificate online through the Florida Department of Health's website. However, additional fees may apply for online orders. Ensure you have all required information and payment details ready when placing your order.

What happens if I provide false information on my application?

Providing false information on your application is a serious offense. It is considered a felony of the third degree in Florida. This means that if you knowingly provide incorrect information, you could face legal consequences. Always ensure that the information you submit is accurate and truthful.

Common mistakes

  1. Incomplete Information: Many applicants forget to fill out all required sections of the form. It's essential to provide complete details, including the child's full name, date of birth, and parents' names. Missing information can lead to delays or rejection of the application.

  2. Incorrect Identification: Submitting an application without valid photo identification is a common mistake. Make sure to include an acceptable form of ID, such as a driver’s license or passport, especially if you are making a mail request.

  3. Misunderstanding Eligibility: Some people are unaware of who can request a birth certificate. Only specific individuals, like parents or legal guardians, are eligible. If you don’t meet the criteria, you may need additional documentation, such as a court order.

  4. Neglecting to Sign: Forgetting to sign the application is another frequent oversight. The applicant's signature is mandatory, so double-check that you’ve included it before submitting the form.

  5. Ignoring Payment Instructions: Applicants sometimes overlook the payment section. Ensure you include the correct fees and payment method, as incomplete or incorrect payments can also delay processing.

Documents used along the form

When applying for a Florida Birth Certificate, several other forms and documents may be necessary or helpful. Each of these documents serves a specific purpose in the process of obtaining vital records. Below is a list of commonly used forms and documents associated with the Florida Birth Certificate application.

  • Affidavit to Release a Birth Certificate (DH Form 1958) - This form must be completed by an authorized person if the applicant is not the registrant, parent, guardian, or legal representative. It provides the necessary authorization for the release of the birth certificate.
  • Death Certificate - If the registrant is deceased, a death certificate is required to obtain a birth certificate for the deceased individual. It establishes the relationship of the requester to the deceased.
  • Guardianship Papers - Legal documents proving guardianship are necessary for guardians who are requesting a birth certificate on behalf of the registrant. These papers must accompany the application.
  • Legal Representative Documentation - Attorneys must provide proof of representation, including their bar number and the relationship of the client to the registrant, when requesting a birth certificate.
  • Photo Identification - Acceptable forms include a Driver’s License, State Identification Card, Passport, or Military Identification Card. This identification must be presented or submitted with the application.
  • Application for a Social Security Number - This form is often needed for newborns to apply for their Social Security number. It may be submitted alongside the birth certificate application.
  • Request for Certified Copy of Birth Certificate - This request form specifies that a certified copy of the birth certificate is being requested, detailing the information needed for processing.
  • Payment Form - A form indicating the method of payment (check, money order, or credit card information) is required to cover the fees associated with obtaining the birth certificate.
  • Amendment Form - If changes are needed on the birth certificate, such as name changes, an amendment form must be completed and submitted for processing.
  • Proof of Relationship Documentation - This may include marriage certificates, birth certificates of children, or other legal documents establishing the relationship of the requester to the registrant.

Having the appropriate documents ready can streamline the process of obtaining a Florida Birth Certificate. Ensure that all forms are completed accurately and submitted with the necessary identification to avoid delays.

Similar forms

The Florida Death Certificate serves a similar purpose to the Birth Certificate, as it provides essential information about a deceased individual. This document includes details such as the deceased's full name, date of birth, date of death, and place of death. Just like the Birth Certificate, a Death Certificate can be requested by certain individuals, including family members and legal representatives. It also requires valid identification and may involve a fee for obtaining certified copies.

The Marriage Certificate is another document that shares similarities with the Florida Birth Certificate. It records the legal union between two individuals and includes important details like the names of both spouses, the date of the marriage, and the location where the marriage took place. Just as with a Birth Certificate, a Marriage Certificate can be requested by the individuals named on the document or their legal representatives, often requiring proof of identity.

The Divorce Decree is akin to the Birth Certificate in that it provides official documentation of a significant life event. This document outlines the dissolution of a marriage and includes details such as the names of both parties, the date of the divorce, and any relevant court orders regarding child custody or property division. Like the Birth Certificate, obtaining a Divorce Decree typically requires identification and may involve a fee.

A Social Security Card is another document that serves as an official record of an individual's identity. It includes the person's name and Social Security number, which is essential for various legal and financial transactions. Similar to the Birth Certificate, obtaining a Social Security Card requires valid identification and may involve specific forms to be filled out, especially for name changes or replacements.

The Passport is a government-issued document that certifies an individual's identity and citizenship. It includes the person's name, date of birth, and photograph. Like the Birth Certificate, applying for a passport requires proof of identity, and the application process includes submitting specific forms and paying a fee. Both documents are crucial for travel and legal identification.

The Adoption Certificate is similar to the Birth Certificate in that it provides a legal record of a person's adoption. It includes the adopted child's name, the names of the adoptive parents, and the date of the adoption. Obtaining an Adoption Certificate often requires a request from the adoptive parents or legal guardians, along with proof of identity, similar to the process for a Birth Certificate.

The Court Order is another document that can be related to a Birth Certificate, particularly in cases involving custody or name changes. A Court Order provides legal authority regarding specific issues and includes details about the parties involved and the court's decisions. Requesting a copy of a Court Order usually requires identification and may involve fees, similar to obtaining a Birth Certificate.

The Voter Registration Card serves as an official document that confirms an individual's eligibility to vote. It includes personal information such as the name, address, and date of birth of the voter. Like the Birth Certificate, applying for a Voter Registration Card requires proof of identity and may involve completing specific forms.

The Military Discharge Papers, also known as DD Form 214, provide official documentation of a service member's discharge from military service. This document includes the service member's name, date of birth, and details about their service. Similar to a Birth Certificate, obtaining Military Discharge Papers requires proof of identity and may involve specific requests based on the individual's relationship to the service member.

Finally, the Certificate of Naturalization is a document that confirms an individual's citizenship status after they have completed the naturalization process. It includes the person's name, date of birth, and the date they became a citizen. Like the Birth Certificate, applying for a Certificate of Naturalization requires proof of identity and may involve fees and specific forms to complete.

Dos and Don'ts

When filling out the Florida Birth Certificate form, it is essential to follow specific guidelines to ensure your application is processed smoothly. Here are nine important dos and don’ts to keep in mind:

  • Do read both the front and back of the application thoroughly before starting.
  • Do provide valid photo identification if you are the applicant.
  • Do fill in the child’s full name exactly as it appears on the birth record.
  • Do indicate any name changes clearly in the designated section.
  • Do specify your relationship to the registrant accurately.
  • Don't submit the application without a signature; it is mandatory.
  • Don't forget to include any required additional documentation, such as guardianship papers if applicable.
  • Don't use a form of identification that is not on the acceptable list.
  • Don't assume that the fees are refundable; all vital record fees are nonrefundable.

By adhering to these guidelines, you can help ensure that your application for a Florida Birth Certificate is completed correctly and efficiently.

Misconceptions

Misconceptions about the Florida Birth Certificate form can lead to confusion and delays in obtaining important documents. Here are nine common misunderstandings:

  • Only the registrant can apply for a birth certificate. Many believe that only the individual named on the birth certificate can request it. However, parents, legal guardians, and authorized representatives can also apply.
  • Photo ID is not necessary for mail requests. Some think they can send in the application without identification. In fact, a copy of valid photo identification must be included for mail requests.
  • All birth records are available for immediate access. People often assume that all birth records can be obtained quickly. However, some records may be sealed due to adoption or court orders, requiring additional steps to access.
  • Birth certificates are free of charge. There is a common belief that obtaining a birth certificate is free. In reality, there are fees associated with the application process, including a non-refundable search fee.
  • Any form of ID is acceptable. Many applicants think that any identification will suffice. The form specifies acceptable IDs, such as a driver’s license or passport, and others may not be valid.
  • It’s unnecessary to specify the relationship to the registrant. Some applicants overlook the importance of clearly stating their relationship to the person named on the certificate. This information is crucial for processing the request.
  • Only certified copies are valid. There is a misconception that only certified copies of birth certificates are usable. However, computer certifications are also accepted by state and federal agencies for various purposes.
  • Requests can be made without proper documentation. Many individuals believe they can submit a request without all required documents. Incomplete applications can lead to delays or rejections.
  • All birth records date back to 1865. Some assume that all birth records are available from 1865 onwards. In fact, birth registration was not mandatory until 1917, so records before that may be limited.

Understanding these misconceptions can help streamline the process of obtaining a Florida birth certificate and ensure that applicants are well-prepared.

Key takeaways

  • Complete the application carefully. Fill out all sections accurately, including the child's full name, date of birth, and parents' names as they appear on the birth record.

  • Provide valid photo identification. If you are the applicant, you must include a valid photo ID, such as a driver's license or passport, with your application.

  • Be aware of eligibility requirements. Only certain individuals, like the registrant, parents, legal guardians, or legal representatives, can request a birth certificate.

  • If you are not the registrant or a parent, you need an affidavit completed by an authorized person to proceed with your request.

  • Understand the fees involved. The first certified copy costs $13, and additional copies are available at a reduced rate of $8 each. Other fees apply for rush orders and optional services.

  • Know that all fees are nonrefundable. If your application is incomplete or your eligibility cannot be verified, you will not receive a refund.

  • For records under seal, such as those related to adoption, you must contact the Bureau of Vital Statistics directly to request a copy.

  • Keep in mind that applications can be submitted in person or by mail. If mailing, ensure you include all necessary documentation and payment to avoid delays.