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Fill Out a Valid Florida Birth Certificate Template

The Florida Birth Certificate form, officially known as the APPLICATION FOR A FLORIDA BIRTH RECORD, is issued by the Florida Department of Health in Pinellas County/Office of Vital Statistics for births registered from 1917 to the present. Designed to facilitate the process of obtaining a certified copy of a birth record, the form requires the applicant to provide detailed personal information and valid photo identification. Eligibility to apply extends to the individual named on the record, parents, legal guardians, legal representatives, and others as permitted under specific guidelines.

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Fill Out a Valid Florida Birth Certificate Template

Table of Contents

Obtaining a birth certificate in Florida is a process made straightforward by the Florida Department of Health in Pinellas County/Office of Vital Statistics, with comprehensive instructions and requirements detailed in the APPLICATION FOR A FLORIDA BIRTH RECORD form. This essential document, offering access to birth records from 1917 onward, mandates that applicants provide valid photo identification and, for requests via mail, a copy of this identification. It addresses various applicants including the individual the record concerns, parents, guardians, legal representatives, or those with a court order. Highlighting the serious nature of the application, it warns against the provision of false information. Detailed in the form are also sections on registrant information, applicant details, and the accompanying fee structure, which outlines the costs associated with obtaining certified copies and additional services such as notary or expedited delivery. Notably, the form emphasizes the availability of computer certifications recognized by state and federal agencies, suitable for travel among other uses, alongside guidelines on eligibility which include provisions even for obtaining records under seal due to circumstances like adoption or court orders. Through clear stipulations on order requirements and acceptable forms of identification, the application process is designed to be navigable yet secure, ensuring that sensitive personal information is handled with the utmost care and respect.

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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
	IF ATTORNEY, PROVIDE
	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

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Document Overview

Fact	Detail
Form Name	Application for a Florida Birth Record
Years Available	1917 to present
Issuing Body	Florida Department of Health in Pinellas County/Office of Vital Statistics
Address	8751 Ulmerton Rd., Ste. 1700, Largo, FL 33771
Contact Information	Phone: #727-507-4330 x 6316; Fax: #727-507-4335
Eligibility	Registrant, Parents, Legal Guardian, Legal Representative, or Other Authorized Individuals
Required Identification	Driver’s License, State Identification Card, Passport, Military Identification Card, or Notarized Affidavit with ID
Governing Law	Chapter 382, Florida Statutes
Penalty for False Information	Felony of the third degree, according to Chapter 775, Florida Statutes
Fee Structure	First Certified Copy: $13; Additional: $8; Other fees for rush orders, delivery, and optional services

Instructions on How to Fill Out Florida Birth Certificate

Filling out the Florida Birth Certificate form is an important step in obtaining a formal record of a birth. This document serves multiple purposes, from legal identification to personal verification. The process is straightforward but requires attention to detail to ensure all information is accurate and the application is accepted without delay. Here's how to complete the form step by step.

Read both the front and back of the application thoroughly before filling anything out. This ensures understanding of all requirements and instructions.
Under SECTION A: REGISTRANT INFORMATION, fill in the child's full name as it appears on the birth record. If the child's name has been changed since birth, include the new name as well.
Enter the child's date of birth in the format MONTH/DAY/YEAR, followed by the gender, state file number (if known), and details about the birth location, including city, county, and hospital.
In the spaces provided, type the mother’s/parent's name before the first marriage and the father's/parent’s name where applicable.
Moving to SECTION B: APPLICANT INFORMATION, write the name of the adult requesting the certificate, ensuring to include any suffixes. Add your signature right below your printed name.
Include your home phone number and a secondary phone number if available, as well as the full mailing address, city, state, and zip code. If the applicant is an attorney, the license/bar number along with the name of the person represented and their relationship to the registrant must be provided.
Under SECTION C: COUNTY HEALTH DEPARTMENT FEE INFORMATION, indicate the number of copies requested and calculate the total cost accordingly. Choose any additional services if needed, like rush orders or notary services.
For payment, provide the Credit Card Holder's name, credit card number, expiration date, security code, billing address/zip, and the cardholder's signature.
Re-check all sections for accuracy and completeness to avoid any processing delays.
Send the completed form along with any required documents, such as a copy of the applicant’s valid photo ID (and guardianship papers or legal representative information if applicable) to the specified address. If submitting by mail, ensure to include all necessary payment forms.

After submitting the application, the processing time can vary. Keeping a copy of the application and any correspondence can be helpful for tracking purposes and any follow-up that may be required. Remember, accuracy in filling out the form avoids delays, ensuring a smooth process to secure the birth certificate.

Listed Questions and Answers

Who can order a Florida Birth Certificate?

Florida Birth Certificates can be ordered by the following individuals: the person named on the birth record if they are of legal age (18), parent(s) listed on the Birth Record, legal guardian (with guardianship papers), legal representative of one of the mentioned persons, or others by court order (with a recorded or certified copy of the order). If the person named on the birth record has passed away, the certificate can be issued to their spouse, child, grandchild, sibling (if of legal age), or their legal representative, as well as to a parent.

What identification is required to order a Birth Certificate?

To order a Birth Certificate, one must provide a completed application along with valid photo identification. Acceptable forms of identification include a Driver’s License, State Identification Card, Passport, and/or Military Identification Card. If requesting by mail, a copy of the valid photo identification must be enclosed. For those not possessing the above IDs, an application must be completed and submitted along with the notarized Affidavit to Release A Birth Certificate form and copies of the applicant's and registrant’s valid photo identifications.

What information is provided on a computer certification of a registered birth?

For births registered from 2004 to the present, the certification supplies the child's name, date of birth, sex, time of birth, weight, place of birth (including city, county, and location), and parent's information. For births registered from 1930 to 2003, the certification includes the child's name, date of birth, sex, and parents' names.

How much does it cost to obtain a certified copy of a Florida Birth Certificate?

The cost for the first certified copy of a birth record is $13.00, which is a non-refundable fee that covers the search for the record. Each additional certified copy, if ordered the same day for the same person, costs $8.00. There are additional charges for optional services such as protective plastic sleeves, rush orders, FedEx delivery, and notary services.

Can I order a Birth Certificate online and are there additional fees?

Yes, Birth Certificates can be ordered online through the county health department's website. Additional fees may apply for online orders, including delivery and service charges.

What records are available for request?

Birth records from 1917 to the present year are available for request. While birth registration was not mandated by state law until 1917, there are some records on file dating back to 1865.

What are the requirements for ordering a Birth Certificate?

The applicant must be eligible (see eligibility criteria above), complete the application form, and provide valid photo identification. Legal guardians must include a copy of the guardianship papers, and legal representatives should provide their attorney bar number along with information on whom they represent and the relationship to the registrant. Agents of local, state, or federal agencies must indicate their agency name in the relationship field.

How long does it take to process a Birth Certificate request?

While processing times can vary, fax or mail rush orders are typically mailed out within 2-3 business days by regular mail. If optional FedEx delivery is selected, the order is mailed out within 2-3 business days to continental U.S. addresses, excluding P.O./APO boxes.

Are there any birth records that cannot be ordered in the usual manner?

Yes, birth records under seal, such as those sealed by reason of adoption, paternity determination, or court order, cannot be ordered using the standard procedure. For these records, one must write directly to the Bureau of Vital Statistics, Attention: Records Amendment Section, with the appropriate documentation.

Is the fee for a Birth Certificate refundable?

No, the fee for a Birth Certificate is nonrefundable. An eligibility verification will be completed before the search fee is charged, especially in cases where additional forms and payment may be required.

Common mistakes

Not reading the instructions thoroughly: Many applicants overlook the importance of reading both the front and back of the application form, where crucial instructions, including the requirement of submitting valid photo identification and the eligibility criteria for applicants, are detailed. This lack of attention can lead to submission of incomplete applications or failure to provide necessary documents.
Incorrect or incomplete name information: It's vital to enter the child's full name exactly as it appears on the birth record, including any suffixes. If the child's name has been legally changed since the birth, the new name must be indicated correctly. Failing to do so can cause delays or result in the rejection of the application.
Failing to provide appropriate identification: The form requires a copy of a valid photo identification if the application is made via mail. Acceptable forms include Driver’s License, State Identification Card, Passport, and/or Military Identification Card. Neglecting to enclose this, or providing a form of identification not listed as acceptable, can prevent the processing of the application.
Incorrectly stating the relationship to the registrant: Applicants must clearly indicate their relationship to the person on the birth record. Simply stating "relative" or providing incorrect information can lead to delays. The form outlines who is eligible to apply, and this section must be completed with accuracy to ensure the application is processed.
Omitting fee payment or providing incorrect fee amounts: The application details the exact costs associated with obtaining the birth record and any additional services like rush orders or protective plastic sleeves. Applicants sometimes forget to include the fee, submit the incorrect amount, or choose an incorrect payment method, which can complicate the processing of their request.

Documents used along the form

When handling matters related to the Application for a Florida Birth Record, individuals often find the need to gather additional documents to support their application or to fulfill other related needs. These documents vary in purpose, from establishing identity to amending information on official records. Here is a brief overview of other forms and documents frequently used in conjunction with the Florida Birth Certificate form.

Social Security Card Application (Form SS-5): This form is used to apply for a new or replacement Social Security card. It is crucial for tax purposes, employment, and accessing government services.
Passport Application (Form DS-11): Required for international travel, this form is used to apply for a U.S. passport. A certified birth certificate is often required as proof of U.S. citizenship.
Driver’s License Application: When applying for a first driver's license or identification card in Florida, an original or certified copy of a birth certificate is typically required to verify the applicant's identity and legal presence.
Affidavit to Release A Birth Certificate (DH Form 1958): This affidavit is necessary when the person requesting the birth certificate is not one of the eligible individuals listed but has a valid reason to obtain the record, such as a legal representative with proper authorization.
Marriage License Application: Couples planning to marry in Florida may need to provide birth certificates during the marriage license application process to verify their identities and ages.
Court Order for Amendment of Birth Record: If there’s a need to amend the birth certificate, such as a name change or correction of vital information, a court order must be secured and submitted to the Office of Vital Statistics.
Application for Amendment of Florida Birth Record (DH 429): This form is used to make changes to a Florida birth record. It is typically submitted along with supporting documents, depending on the nature of the amendment.

The aforementioned documents play a supportive role in various legal, personal, and administrative matters, demonstrating the multifaceted use of birth records. Whether for registration in the public school system, application for government benefits, or correction of personal information, these documents, alongside the Florida Birth Certificate, are essential in navigating both governmental and non-governmental processes efficiently and effectively.

Similar forms

The Florida Birth Certificate form is similar to other vital records forms such as the Application for a Marriage Certificate and the Application for a Death Certificate, among others. These documents share a format and purpose: to officially record and provide proof of significant life events. They are structured to collect detailed, personal information and require validation through official identification. Additionally, these forms stipulate legal responsibilities and consequences for the provision of false information, reinforcing their official nature and the serious manner in which they must be handled.

Application for a Marriage Certificate bears a resemblance to the birth certificate application in several ways. It requests detailed personal information of both parties involved in the marriage, including full names, places of birth, and parents’ names, similar to the birth certificate form which collects the child’s and parents’ names, as well as the place of birth. Both forms also include sections for the applicant's details, emphasizing the relationship to the individuals named on the record. These applications serve as a means to officially document and recognize significant personal and familial milestones within the state’s records.

Application for a Death Certificate also shares similarities with the birth certificate form. It is designed to collect comprehensive information about the deceased, including date and place of birth, mirroring the birth certificate's collection of birth details. Like the birth certificate application, a death certificate application requires information about the deceased’s parents and must be completed by eligible parties, such as immediate family members or legal representatives. Both documents include strict warnings about the provision of false information, highlighting the legal importance of the data provided.

Each of these forms plays a critical role in documenting vital events in a person’s life, serving both legal and personal purposes. Despite the differences in the events they record, the applications share a common framework focused on accuracy, legality, and eligibility of requesters, underlining the state's commitment to maintaining precise and accessible records for its citizens.

Dos and Don'ts

When completing the Florida Birth Certificate form, ensuring accuracy and adherence to official guidelines is imperative for a smooth application process. The following enumerates essential do's and don'ts to guide you.

Do:

Read both the front and back of the application thoroughly. This ensures understanding of all requirements and instructions necessary for successful form submission.
Provide accurate information for every section. False information can lead to legal consequences, including felony charges.
Include valid photo identification with the application. If mailing the request, a copy of valid photo identification must also be included.
Verify the relationship to the registrant, if not applying for oneself. Eligibility is strictly defined, and proper documentation or identification must support the application.
Ensure that all requested documentation for legal guardians, legal representatives, or other authorized persons is submitted. This includes guardianship papers, attorney bar numbers, or court orders as applicable.
Sign the application. A signature, alongside printed name, residence address, and telephone number, is a necessary part of the application process.

Don't:

Leave any sections incomplete unless specified. Information gaps can result in processing delays or rejection of the application.
Provide false information. Integrity in reporting is mandated, as false statements can result in felony charges.
Forget to include the payment for the applicable fees. Details regarding fees for certified copies and additional services are listed in Section C of the form.
Overlook the need for additional forms if applying as a legal guardian or representative. Proper documentation is required to validate eligibility.
Assume eligibility. If you do not fall under the categories of self, parent, guardian, legal representative, or are not acting under court orders, verify your eligibility before application.
Use unofficial channels for submission without verifying their authenticity. Ensuring the application is submitted through the proper Florida Department of Health channels protects against fraud.

Misconceptions

When it comes to obtaining a birth certificate in Florida, there are several common misconceptions that can lead to confusion. Understanding these can help streamline the process and avoid unnecessary errors or delays. Here are eight myths debunked:

Anyone can request a Florida birth certificate. In reality, Florida birth certificates can only be issued to the child named on the record if of legal age, parent(s) listed on the birth record, legal guardian, legal representative of one of the aforementioned individuals, or other person(s) by court order. This ensures the privacy and security of personal information.
All birth records are public. Certain birth records, such as those under seal by reason of adoption, paternity determination, or court order, cannot be ordered in the usual manner. These records are protected to maintain the individuals' privacy.
You can get a birth certificate for any year. While the state of Florida has records dating back to 1865, birth registration was not mandatory by state law until 1917. This means records prior to 1917 may be incomplete or unavailable.
A birth certificate is free. There is a non-refundable fee for searching and obtaining a certified copy of a birth record. These fees contribute to the maintenance and accessibility of vital records.
You can request a birth certificate without ID. A valid photo identification is required when requesting a birth certificate to ensure that the requester has a legitimate right to obtain the record. If requesting by mail, a photocopy of the ID must be provided.
Only a legal parent or guardian can request a minor's birth certificate. While it’s true that parents and legal guardians can request a birth certificate, legal representatives or individuals with a court order may also obtain a birth certificate for the child.
All requests are processed online. Although online requests are available and may include additional fees, birth certificates can also be requested by mail or in person at the office listed on the application form. This caters to different preferences and needs.
The processing time is the same for all requests. Processing times can vary depending on the method of request and current demand. Rush orders and optional Fed/Ex delivery are available for faster processing, subject to additional fees.

Clearing up these misconceptions can help individuals navigate the process of obtaining a Florida birth certificate more efficiently and with greater confidence.

Key takeaways

When applying for a Florida Birth Certificate, it is crucial to pay attention to several key points that ensure the application process is smooth and successful. Here are the top takeaways to consider:

The application must be filled out by the registrant, parent, guardian, or legal representative, accompanied by valid photo identification. For mail requests, a copy of the valid ID is required.
If the person requesting the birth certificate is not the registrant, a parent, guardian, or legal representative, an Affidavit to Release a Birth Certificate must be completed and submitted.
Acceptable forms of identification include a Driver’s License, State ID Card, Passport, and/or Military ID Card.
The application needs to include comprehensive information about the child, including the full name as it appears on the birth record and any changes to the name after birth.
Information regarding the child's parents must be accurately provided, detailing names before any marriage if applicable.
It is a felony of the third degree to willfully and knowingly provide false information on the application, which is punishable under Chapter 775, Florida Statutes.
Birth certificates are available from 1917 to the present, although records dating back to 1865 may be on file.
Eligibility to obtain a birth certificate extends to the registrant (if of legal age), parents listed on the birth record, legal guardians, legal representatives, and others as determined by court order.
Fees for obtaining a certified copy of a birth certificate include a non-refuable search fee, with additional fees for extra copies, rush orders, and optional services like notary or expedited shipping.
It is important to check the box for computer certification, as it is accepted by all state and federal agencies and can be used for any type of travel, providing specific facts of birth based on the year of registration.

Ensure that all provided information is accurate and clearly written to prevent any delays. The process of obtaining a birth certificate in Florida is designed to be straightforward, provided that the application is completed correctly and all necessary documentation is included.

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