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The Florida Birth Certificate form plays a crucial role for individuals seeking to obtain official records of birth in the state of Florida. Available for individuals born from 1917 to the present, this application is governed by the Department of Health in Pinellas County. It requires specific information from the applicant, including key details about the registrant, such as full name, date of birth, and parent information, among others. Additionally, the applicant must establish their eligibility to request the certificate, which is limited to certain individuals such as the registrant, parents, legal guardians, or legal representatives. The form emphasizes the importance of providing valid photo identification to ensure security and accuracy, especially in mail requests. Furthermore, various fees are associated with the application, including costs for certified copies and additional services like notary or expedited delivery options. The application outlines serious consequences for providing false information, which is considered a felony. Additionally, specific protocols apply for records that are sealed due to reasons like adoption or court orders. This comprehensive form serves not only as a record request but also as a legal document, facilitating access to vital information while ensuring compliance with state regulations.

Florida Birth Certificate Example

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

Form Characteristics

Fact Name Fact Description
Eligibility for Issuance Birth certificates may be issued to the registrant, parent(s), legal guardian, or legal representatives. Others can obtain a birth certificate only through a court order.
Identification Requirements Applicants must provide valid photo identification. Acceptable forms include a Driver’s License, State ID Card, Passport, or Military ID.
Application Method Applications can be submitted in person or by mail. For mail requests, copies of valid photo identification must accompany the application.
Fees for Copies The cost for the first certified copy is $13. Additional copies ordered on the same day are $8 each. Fees are nonrefundable.
Governing Statutes The process for obtaining a birth certificate is governed by Chapter 382 and Chapter 775 of the Florida Statutes.

Guidelines on Utilizing Florida Birth Certificate

Completing the Florida Birth Certificate form involves several important steps. Careful attention to the instructions will help ensure that the application is filled out correctly and processed efficiently. After filling out the form, it should be submitted along with any required identification and payment.

  1. Obtain the Florida Birth Certificate application form from the Florida Department of Health or download it from their official website.
  2. Read through both the front and back of the application to understand the requirements and necessary documentation needed for your request.
  3. In Section A, fill out the information regarding the registrant, providing the child's full name (as shown on the birth record), date of birth, place of birth, and parents' names as applicable.
  4. Proceed to Section B and enter your information as the applicant. Include your full name, relationship to the registrant, and contact information.
  5. If applicable, include your license or bar number if you are an attorney representing someone else.
  6. In Section C, calculate the fees based on the number of copies and services you are requesting. Indicate the method of payment, whether through credit card or check.
  7. Sign the application at the designated area to confirm that all information provided is accurate.
  8. Attach a valid photo identification to your application. Acceptable forms include a driver’s license, state ID, passport, or military ID.
  9. If you are mailing the application, make a copy of the photo identification to include with your submission.
  10. Once all sections are completed and documents are attached, submit the application either in person or by mail to the Office of Vital Statistics at the provided address.

What You Should Know About This Form

What is the Florida Birth Certificate application process?

The application for a Florida Birth Certificate can be obtained from the Florida Department of Health in Pinellas County. To apply, individuals must complete the application form and provide valid photo identification. This includes options such as a Driver’s License, State Identification Card, Passport, or Military Identification Card. If applying by mail, include a copy of the valid ID. The application must be signed and submitted along with any required fees.

Who is eligible to request a birth certificate?

Eligibility to request a birth certificate in Florida is limited to specific individuals. These include the registrant (the person named on the certificate), parents listed on the record, legal guardians, and legal representatives of the eligible parties. In cases where the registrant is deceased, the spouse, child, grandchild, sibling, or a legal representative may request the certificate, given that a death certificate is provided.

What identification is required when applying?

Applicants must provide a valid form of photo identification. Acceptable forms include a Driver’s License, State Identification Card, Passport, or Military Identification Card. If someone other than the registrant or their immediate family is applying, additional documentation such as a notarized Affidavit to Release a Birth Certificate may also be required, along with a copy of the registrant’s ID.

What fees are associated with obtaining a birth certificate?

The fees for obtaining a birth certificate are as follows: the first certified copy costs $13.00, while additional certified copies of the same record purchased on the same day are $8.00 each. Optional services include a protective plastic sleeve for $2.00 and rush mail ordering for $5.00. For FedEx delivery, the cost is $17.00. All fees are nonrefundable.

How long does it take to receive a birth certificate?

Processing times can vary, but typically birth certificates requested by mail are mailed out within 2-3 business days. Expedite options, such as rush orders, may be available for an additional fee. It's advisable to allow extra time for any mail delays or for requests requiring approval from other entities.

Can I obtain a birth certificate if the birth record is under seal?

Birth records that are under seal, such as those resulting from adoptions or court orders, cannot be obtained through the standard application process. To request these records, applicants must contact the Bureau of Vital Statistics directly and provide any necessary documentation that justifies their request.

What should I include if I am applying as a legal representative?

If applying as a legal representative, it is necessary to provide details about the individual you represent. This includes their name, the relationship to the registrant, and the attorney bar number if applicable. A signed authorization from the registrant may also help streamline the process.

Are there any instances where my application could be denied?

Applications can be denied if the required identification is not provided, if the applicant does not meet eligibility criteria, or if the application is incomplete. Additionally, providing false information will lead to a denial and possible legal consequences, as it is considered a felony offense.

Is there a way to apply online for a Florida Birth Certificate?

Yes, individuals can apply for a Florida Birth Certificate online through the Florida Department of Health's website. However, be aware that additional fees may apply for online applications. Ensure to complete all required fields and provide a method for payment.

What if I need to change the name listed on the birth certificate?

To change a name on a birth certificate, you must submit an amendment form along with the required documentation and fees. The process may involve legal steps depending on the nature of the name change, such as providing marriage certificates or court orders. Notary services for these forms may be available for an additional fee.

Common mistakes

When filling out the Florida Birth Certificate form, individuals often make several mistakes that can delay the process. One common error is incomplete information. It is crucial to provide all requested details accurately in the registrant information section. Omitting any part of the child's name or date of birth can lead to rejection of the application.

Another frequent mistake is failing to specify the relationship to the registrant. Applicants must clearly indicate their relationship in order to establish eligibility. Those applying for someone other than themselves must provide specific details about how they are related to the registrant.

Not providing valid photo identification is also a significant misstep. Whether applying by mail or in person, applicants need to attach a copy of their identification. Acceptable forms include a driver's license, state ID card, passport, or military ID. Without this documentation, the application may be postponed or denied.

Incorrectly entering the parent’s names can lead to complications. If the mother's or father's name has changed since the birth, it is important to include the name prior to marriage as specified in the form.

Inaccuracies regarding the child’s full name or date of birth can easily result in the need for resubmission. Double-checking these fields before submission is essential. Applicants should ensure that the spelling matches what appears on the original birth record.

Some individuals also overlook the section for fees. Not including the required payment can cause delays. Ensure that the total amount is calculated accurately and that checks or money orders are made payable to Vital Statistics. Online payments should follow the specified procedure to avoid complications.

Applicants might forget to sign the form. The signature of the individual requesting the birth certificate is mandatory. Without it, the application will not be processed. A printed name and contact information are also required alongside the signature for verification purposes.

People often misinterpret the instruction regarding non-refundable fees. It is important to understand that once the payment is made, it cannot be refunded. This means applicants should only submit the fee if they are fully confident in their eligibility to receive the birth certificate.

Finally, those filing for certificates under special circumstances, such as adoptions or legal name changes, frequently fail to include additional required documentation. If applicable, ensure that all necessary forms, such as a notarized affidavit or court order, accompany the application to avoid delays in processing.

Documents used along the form

When applying for a Florida Birth Certificate, you may encounter several other forms and documents that relate to the process. Each of these plays a crucial role, ensuring that you can obtain the necessary documentation efficiently and legally. Below is a list of additional forms and documents commonly used alongside the Florida Birth Certificate form.

  • Affidavit to Release a Birth Certificate: This form is used when someone other than a parent, legal guardian, or authorized representative is requesting a birth certificate. It must be completed by an authorized person and submitted with the application.
  • Application for Birth Record: This is the main document that applicants must fill out when requesting a birth certificate. It collects essential details about the registrant and the applicant.
  • Valid Photo Identification: Required identification types include a driver’s license, state ID card, passport, or military identification. A copy must be provided when submitting a mail request.
  • Death Certificate: In cases where the registrant is deceased, the death certificate may be needed to validate the relationship for ordering the birth certificate for family members or legal representatives.
  • Legal Guardian Papers: If the applicant is a legal guardian of the registrant, this documentation must be included to prove guardianship status.
  • Court Order: In certain circumstances, such as adoption or paternity issues, a court order may be necessary to obtain the birth certificate. This order must be certified and submitted with the application.
  • Proof of Relationship: Applicants may need to provide documentation showing their relationship to the registrant, particularly if they are not a parent or legal guardian.
  • Payment Method Confirmation: A record of the payment method, whether by credit card or money order, is essential to process the application, especially for rush orders or additional certificates.
  • Request for Amendment Form: If there are changes to be made on an existing birth record, an amendment form must be completed and submitted along with the necessary identification and fees.

These additional documents can facilitate a smoother process when obtaining a Florida Birth Certificate. Ensuring that all forms and requirements are correctly completed will help avoid delays and simplify your request.

Similar forms

The Florida Birth Certificate form shares similarities with several other essential documents that serve various purposes in personal identification and legal situations. Below are six documents that align closely with the Florida Birth Certificate in terms of their function and importance:

  • Marriage Certificate: Much like a birth certificate, a marriage certificate verifies a significant life event. It includes the names of both parties, the date of marriage, and often the location. This document is crucial for name changes, tax filings, and legal affairs.
  • Death Certificate: Similar to the birth certificate, a death certificate serves as an official record of an individual's passing. It contains critical information such as the deceased's full name, date and place of death, and family details. This document is often required for settling estates or claiming life insurance benefits.
  • Social Security Card: A social security card provides a unique number assigned to individuals for the purpose of tracking earnings and benefits. Like a birth certificate, it establishes identity and can be mandatory for tax purposes and certain government services.
  • Passport: A passport certifies identity and citizenship, allowing for international travel. Similar to a birth certificate, it includes personal details like full name, date of birth, and place of birth, making it a vital form of identification.
  • Driver’s License: This document serves as both a legal permission to operate a vehicle and a widely accepted form of identification. Like a birth certificate, a driver's license requires proof of identity and often includes the date of birth and personal information.
  • Voter Registration Card: A voter registration card verifies an individual's eligibility to vote in local, state, and federal elections. Similar to a birth certificate, it often requires proof of residency and ID, ensuring the integrity of the voting process.

Understanding these documents can be essential for navigating various life situations, from ensuring compliance with legal requirements to facilitating personal life events. Each serves a specific purpose while sharing fundamental characteristics with the Florida Birth Certificate.

Dos and Don'ts

Do's when filling out the Florida Birth Certificate form:

  • Read both the front and back of the application thoroughly to understand the requirements.
  • Provide valid photo identification along with your application if you are the applicant.
  • Indicate clearly any name changes since birth in the appropriate section.
  • Ensure that your signature and printed name are included on the application form.
  • Check that you have included any necessary documentation, such as guardianship papers if applicable.

Don'ts when filling out the Florida Birth Certificate form:

  • Do not provide false information, as this can have legal consequences.
  • Do not forget to specify your relationship to the registrant if you are not the registrant.
  • Do not submit the application without a completed affidavit if you are not listed as an eligible requester.
  • Do not neglect to include all relevant phone numbers for easier communication.
  • Do not skip the fee payment section; ensure that your payment method is included and clear.

Misconceptions

There are several misconceptions surrounding the Florida Birth Certificate application process. Understanding the facts can help applicants navigate this important process more effectively. Here are five common misconceptions:

  • Misconception 1: All birth certificates are available to anyone who requests them.
  • In reality, birth certificates can only be issued to specific individuals. These include the registrant, their parents, legal guardians, and legal representatives. In some cases, a court order may be required for other persons to access this information.

  • Misconception 2: A birth certificate request can be made without identification.
  • Identification is a crucial part of the application process. The applicant must provide valid photo identification, such as a driver’s license or passport. If the request is made via mail, a copy of this identification must also be included.

  • Misconception 3: All birth records are the same and contain identical information.
  • This is not accurate. Birth records are categorized based on the date they were issued. For example, records from 2004 onwards include detailed information such as time of birth and weight, while those from 1930 to 2003 offer more limited details.

  • Misconception 4: Fees for obtaining a birth certificate are refundable.
  • Applicants should be aware that vital record fees are nonrefundable. This fee is charged even if the search does not yield a result. Applicants should ensure they qualify for the document before submitting payment.

  • Misconception 5: Name changes can be reflected immediately on the birth certificate.
  • Changes to a registrant's name must follow legal procedures before being updated on the birth certificate. Proper documentation, such as marriage certificates or legal name change orders, must be submitted to initiate this process.

Clarifying these misconceptions can help applicants manage their expectations and streamline the process for obtaining Florida birth certificates.

Key takeaways

Acquiring a birth certificate in Florida involves a few critical steps and understanding specific requirements. Here are some key takeaways to help guide you through the process:

  • Eligibility Requirement: Only certain individuals can request a birth certificate. This includes the registrant (the person named on the record if they are 18 or older), parent(s), legal guardians, and legal representatives. Others may only receive a copy through a court order.
  • Identification Needed: A completed application must be accompanied by valid photo identification. Acceptable forms include a driver's license, a state ID card, a passport, or a military ID.
  • Self-Application: If you are applying for your own birth certificate, simply state “SELF” in the relationship section of the application.
  • Mail Requests: For requests made by mail, you must include a copy of your valid photo ID along with the completed application form.
  • Affidavit Requirement: If you are not eligible to request a birth certificate, you must complete a notarized Affidavit to Release a Birth Certificate. This affidavit must be submitted along with the application and valid IDs.
  • Fees and Costs: The first certified copy of a birth record costs $13.00, while additional copies are available for $8.00 if ordered the same day. Various fees apply for expedited services and protective sleeves.
  • Non-Refundable Fees: Keep in mind that all fees for vital records are nonrefundable, regardless of whether the search or application is successful.
  • Submitting Under Seal Records: Special procedures are required to request sealed records. For such records, you need to write to the Bureau of Vital Statistics with the necessary documents.

Understanding these points can significantly assist in navigating the application process for a Florida birth certificate. It is essential to provide accurate and complete information to avoid delays.