Page 2 of 4 VS-160 (Rev. 3/22)
INSTRUCTIONS:
Once the application is approved, a new birth record will be filed with the adoption information.
Section 1: Birth Certificate Information
• The information completed in this section should show the child’s information prior to this adoption. This
is required to locate the birth certificate our office will be amending.
• The child’s name, date of birth, sex, and place of birth are required.
• Parents’ names are required for Texas-born adoptions; parents’ names are not required for foreign-born
adoptions.
Section 2: Information for New Birth Certificate
• This section must show the adoptive parents information. Do not list married name as maiden name.
• If this is a step-parent adoption, the biological parent’s information should also be included in this
section. A step-parent adoption is NOT a single parent adoption.
• All items in this section are required. Incomplete applications will not be processed.
Section 3: Parent’s Signature
• An adoptive parent’s signature is required. Incomplete applications will not be processed.
Section 4: Attorney/Placing Agency Information
• Include the name, address and telephone number of the attorney of record.
• If applicable, include the child placing agency or managing conservator.
Section 5: Certification of the Court
• This section must be completed by the clerk of the court granting the adoption, including the new
name of the child.
• If this section is not certified by the clerk of the court granting the adoption, then the applicant may
complete this section and must submit a certified copy (with the original certification) of the final
decree of adoption. The adoption decree must properly identify the birth record to be amended –
including the child’s original name, date of birth and adoptive name. For foreign-born adoptions, the
adoption decree must also include the country of birth.
Please note: All documents, both certified and photocopied, submitted will be retained by our
office and placed in a sealed file. A court order is required to unseal a file. Parents should keep copies
of certified documents for their records and future use before sending them.
Section 6: What is Your Name? (Applicant’s Information)
• This section must be completed with the applicant’s contact information and relationship to the person
named on the birth certificate. District clerks do not need to complete this section.
• This section must include to whom our office will mail the newly filed birth certificate.
• A copy of the applicant’s valid photo ID must be included with the application.
Section 7: Would the applicant like to order a certified copy of the new birth record?
• The information completed in this section is used by our office to determine if a certified copy of the
newly filed birth certificate reflecting the adoptive information is being ordered and the number of
certified copies being ordered. District clerks do not need to complete this section.
• If a birth certificate is not ordered, this section does not need to be signed in the presence of a notary
public, county clerk, or other person authorized to administer oaths.
• If a birth certificate is ordered, this section must be signed by the applicant in section 6: one of the
adoptive parents, the adult adoptee, or attorney in the presence of a notary public, county clerk, or
other person authorized to administer oaths. The application must include a photocopy of the valid
photo ID for the person signing.
• The notary public’s signature, seal or stamp, and commission expiration date must be shown in this
section.