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The Florida Birth Certificate form is an essential document for individuals seeking to obtain a certified copy of a birth record from the state. Available for births registered from 1917 to the present, this form is managed by the Florida Department of Health in Pinellas County. To initiate the process, applicants must provide valid photo identification and complete the application accurately. The form includes sections for registrant information, which captures details such as the child's full name, date of birth, and parent information. Additionally, applicants must indicate their relationship to the registrant, whether they are the individual themselves, a parent, or a legal representative. The form also outlines the fees associated with obtaining certified copies, including options for expedited processing. It is crucial to understand the eligibility criteria, as only certain individuals can request a birth certificate. For example, a registrant of legal age, parents listed on the record, or legal guardians may apply directly. In cases where the registrant is deceased, immediate family members can request the document with appropriate verification. The application form emphasizes the importance of providing truthful information, as any false statements can lead to serious legal consequences. By following the instructions carefully, applicants can successfully navigate the process of obtaining a Florida Birth Certificate.

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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

 

 

 

 

 

 

 

 

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
➤ PDF File

Form Specifications

Fact Name Description
Application Purpose This form is used to request a Florida birth record for individuals born from 1917 to the present.
Governing Laws The application process is governed by Chapter 382 and Chapter 775 of the Florida Statutes.
Identification Requirement Applicants must provide valid photo identification when submitting the application, especially for mail requests.
Eligibility Criteria Eligible applicants include the registrant, parents, legal guardians, legal representatives, or individuals with a court order.
Record Availability Birth records have been required since 1917, but some records exist as far back as 1865.
Fees for Copies The cost for the first certified copy is $13.00, with additional copies available for $8.00 each.
Computer Certification Computer certifications are accepted by state and federal agencies and come in two formats based on the year of birth.
Nonrefundable Fees All fees paid for vital records are nonrefundable, regardless of the outcome of the request.

Florida Birth Certificate: Usage Guidelines

Completing the Florida Birth Certificate form is a straightforward process that requires attention to detail. Ensure you have all necessary information and identification ready before you begin. Follow the steps below to fill out the application correctly.

  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 to understand the requirements for ordering.
  3. In Section A: Registrant Information, fill in the child’s full name as it appears on the birth record, including any suffix.
  4. If the child’s name has changed since birth, provide the new name in the designated fields.
  5. Enter the date of birth, including the month, day, and year in four digits.
  6. Provide the state file number if known, and indicate the child’s sex.
  7. Fill in the hospital, city or town, and county where the child was born.
  8. List the mother’s and father’s names, including their names prior to any marriages.
  9. In Section B: Applicant Information, enter the applicant’s full name, including any suffix.
  10. Sign the application and provide a printed name along with the home phone number.
  11. Complete the mailing address, including apartment number if applicable, and the relationship to the registrant.
  12. Fill in the alternate phone number and ensure the city, state, and zip code are correct.
  13. If applicable, provide the attorney's license or bar number and the name of the person represented along with their relationship to the registrant.
  14. In Section C: Fee Information, indicate the number of certified copies requested and any additional services, such as protective sleeves or rush orders.
  15. Calculate the total fee and provide payment information, including credit card details if applicable.
  16. Review the completed application for accuracy before submission.
  17. Submit the application along with valid photo identification as required.

Once you have filled out the form and submitted it, the processing time will vary based on the method of request. If you have opted for mail or fax, expect a wait period before receiving the birth certificate. For expedited requests, ensure you have selected the appropriate options and provided all necessary documentation.

Your Questions, Answered

What are the requirements for ordering a Florida birth certificate?

To order a Florida birth certificate, the applicant must be the registrant (the person named on the record), a parent, legal guardian, or legal representative. The applicant must complete the application form and provide valid photo identification. Acceptable forms of ID include a driver's license, state identification card, passport, or military identification card. If the request is made by mail, a copy of the valid photo ID must be included. For those who do not meet these criteria, an Affidavit to Release a Birth Certificate must be completed by an authorized person and submitted along with the application.

What is the cost of obtaining a certified copy of a birth certificate in Florida?

The cost for the first certified copy of a birth certificate is $13.00, which is a non-refundable fee for the search. If additional copies of the same birth record are requested on the same day, each additional certified copy costs $8.00. There are also fees for optional services, such as a protective plastic sleeve for $2.00 and expedited mailing options. It is important to note that all fees are non-refundable, so applicants should ensure they meet eligibility requirements before submitting payment.

Who is eligible to request a birth certificate?

Eligibility to request a birth certificate is limited to specific individuals. The registrant, if of legal age (18 years or older), parents listed on the birth record, legal guardians (with appropriate documentation), and legal representatives of the aforementioned individuals can all request a birth certificate. Additionally, if the registrant is deceased, immediate family members such as a spouse, child, grandchild, or sibling can request the certificate, provided they submit the decedent's death certificate. Individuals seeking records for births that occurred over 100 years ago may also obtain a certified copy without restrictions.

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

Birth records that are sealed due to adoption, paternity determination, or court order cannot be requested through the standard application process. Instead, a written request must be sent to the Bureau of Vital Statistics, specifically to the Records Amendment Section. This request should include any necessary documentation to support the need for access to the sealed record. It is advisable to consult legal counsel if there are questions regarding the process or eligibility for obtaining a sealed birth record.

Common mistakes

  1. Failing to read the entire application thoroughly. Many applicants overlook important instructions on both the front and back of the form.

  2. Not providing valid photo identification. If submitting by mail, applicants must include a copy of their ID, which is often forgotten.

  3. Incorrectly filling out the child's full name. It's essential to ensure the name matches exactly as it appears on the birth record, including any suffixes.

  4. Omitting the date of birth or providing it in an incorrect format. Applicants should use the specified month, day, and four-digit year format.

  5. Neglecting to indicate any name changes since birth. If the child's name has changed, applicants must provide the new name and details about the change.

  6. Not specifying the relationship to the registrant accurately. This is crucial for eligibility, and failure to clarify may delay the application.

  7. Forgetting to sign the application. The applicant's signature is mandatory, and without it, the application cannot be processed.

  8. Misunderstanding the eligibility criteria. Applicants should ensure they meet the requirements to obtain the birth record.

  9. Not including the correct fee for the application. Applicants must check the fee schedule and ensure payment is made accordingly.

  10. Submitting an application for a record under seal without following the specific instructions for such records, which differ from standard requests.

Documents used along the form

When applying for a Florida Birth Certificate, several other forms and documents may be required or helpful in the process. Understanding these documents can streamline your application and ensure you have everything needed for a successful request.

  • Affidavit to Release a Birth Certificate (DH Form 1958): This form is necessary if the applicant is not the registrant, parent, guardian, or legal representative. It must be completed by an authorized person to release the birth certificate.
  • Photo Identification: A valid photo ID is required for the applicant. Acceptable forms include a Driver’s License, State ID Card, Passport, or Military ID. A copy must be provided for mail requests.
  • Guardianship Papers: If the applicant is a legal guardian, they must submit documentation proving their guardianship along with the application.
  • Court Order: For individuals who are not the registrant or a direct family member, a certified copy of a court order may be necessary to obtain the birth certificate.
  • Death Certificate: If the registrant is deceased, the death certificate is required to request a copy of the birth certificate for immediate family members.
  • Payment Form: A completed payment form is needed to cover the fees associated with obtaining the birth certificate. This can include checks, money orders, or credit card information.
  • Application for a Florida Birth Record: The main form itself must be filled out completely, providing all necessary information about the registrant and the applicant.

Having these documents prepared can facilitate the application process for a Florida Birth Certificate. It’s essential to review each requirement carefully to avoid delays and ensure a smooth experience.

Similar forms

  • Social Security Card: Similar to a birth certificate, a Social Security card serves as an official document that verifies an individual's identity and age. It is often required for employment, government services, and tax purposes.
  • Passport: A passport is an internationally recognized document that confirms a person's identity and citizenship. Like a birth certificate, it contains essential personal information such as name, date of birth, and place of birth.
  • Marriage Certificate: This document certifies the union between two individuals and includes names, dates, and locations. Similar to a birth certificate, it is an official record that may be required for legal purposes.
  • Driver’s License: A driver's license serves as a form of identification and includes personal details such as name, date of birth, and address. It is often used in situations where proof of identity and age is necessary.
  • State Identification Card: Like a driver's license, a state ID card provides proof of identity and age. It is particularly useful for individuals who do not drive but still need an official form of identification.
  • Medical Records: Medical records may include information about a person's birth, such as the date and place of birth, along with other health-related details. They serve as an important document for healthcare purposes, similar to a birth certificate.

Dos and Don'ts

When filling out the Florida Birth Certificate form, there are important guidelines to follow. Here are five things to do and avoid:

  • Do provide valid photo identification. This is essential for the application to be processed.
  • Do ensure all names are accurately spelled. Any discrepancies can delay the processing of your request.
  • Do specify your relationship to the registrant. Clearly indicate if you are the parent, guardian, or legal representative.
  • Do check for completeness. Ensure that all required sections of the form are filled out before submission.
  • Do include payment for the application fee. Remember that fees are nonrefundable.
  • Don't submit without a signature. An unsigned application will not be processed.
  • Don't use incorrect identification. Only acceptable forms of ID will be accepted.
  • Don't forget to read the instructions. Familiarize yourself with the requirements to avoid mistakes.
  • Don't skip the eligibility verification. Ensure you meet the criteria before submitting your request.
  • Don't assume the application will be processed immediately. Allow adequate time for processing, especially for mail requests.

Misconceptions

Understanding the Florida Birth Certificate form can be challenging due to several common misconceptions. Here are nine of them, along with clarifications to help navigate the application process more smoothly.

  1. Misconception: Only parents can request a birth certificate.

    While parents are eligible to request a birth certificate, legal guardians and legal representatives can also apply. Others may need a court order to obtain a copy.

  2. Misconception: A birth certificate can be requested without identification.

    Valid photo identification is required for all applicants. If you are submitting a mail request, a copy of your ID must accompany the application.

  3. Misconception: Birth certificates are available for all years.

    Birth registration was not mandated until 1917, although some records exist from as early as 1865. Be aware that older records may not be readily available.

  4. Misconception: The application process is the same for sealed records.

    Records sealed due to adoption or court orders cannot be requested in the usual manner. Specific instructions must be followed, including contacting the Bureau of Vital Statistics.

  5. Misconception: Fees for obtaining a birth certificate are refundable.

    The fees associated with vital records are nonrefundable. This includes the search fee, which is charged before eligibility verification.

  6. Misconception: Only certified copies are acceptable for legal purposes.

    Computer certifications are also valid for legal and travel purposes. They come in two formats, depending on the year of birth.

  7. Misconception: You can order a birth certificate online without any additional fees.

    While online ordering is available, additional fees may apply. It is important to check the website for complete details.

  8. Misconception: You can use any form of identification.

    Only specific forms of identification, such as a driver’s license, state ID, passport, or military ID, are accepted. Ensure you have one of these before applying.

  9. Misconception: The applicant's signature is optional.

    The applicant's signature is mandatory on the application. Incomplete applications may lead to delays or rejections.

By addressing these misconceptions, applicants can better prepare for the process of obtaining a Florida Birth Certificate, ensuring a smoother experience overall.

Key takeaways

  • Understand Eligibility: Only specific individuals can request a birth certificate. This includes the registrant (the person named on the record), parents, legal guardians, and legal representatives.
  • Complete the Application: Fill out the application thoroughly. Ensure all sections are completed accurately to avoid delays in processing.
  • Provide Identification: Valid photo identification is required. Acceptable forms include a driver’s license, state ID card, passport, or military ID.
  • Mail Requests: If you are sending your application by mail, include a copy of your valid photo ID along with the completed form.
  • Non-refundable Fees: Be aware that the fees for birth record searches are non-refundable. Ensure you meet eligibility requirements before submitting payment.
  • Special Cases: If the registrant is deceased, a death certificate must accompany the request for a birth certificate.
  • Records Under Seal: For records sealed due to adoption or court orders, a different process is required. Contact the Bureau of Vital Statistics for guidance.
  • Online Ordering: Consider using the online service for ordering certificates. Additional fees may apply, but it can save time.
  • Keep Copies: Always keep copies of your application and any identification submitted. This can help resolve any issues that may arise during processing.