DH 726, 01/2022, Florida Administrative Code Rule 64V-1.0131 (Obsoletes Previous Editions)
Florida Department of Health
Bureau of Vital Statistics
www.floridahealth.gov/certificates
APPLICATION FOR FLORIDA BIRTH CERTIFICATE
Applicant Information (Eligibility Requirements on Reverse Side)
Any person who willfully and knowingly provides any false information on a certificate, record or report required by Chapter 382, Florida
Statutes, or on an 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.
Applicant’s Name: _____________________________________________________________________________________
(Person requesting the record)
Mailing Address: ______________________________________________________________________ Apt.#: __________
City: _______________________________________________ State: ___________ ZIP Code: _______________________
Phone (with area code): _____________________________ email: _________________________________________________
Relationship to Person on Birth Record: ___________________________ Signature: _______________________________
VitalChek.com is the ONLY online vendor approved by the Florida Department of Health, Bureau of Vital Statistics to assist
customers in completing the application process. Be cautious when sharing personal information online with unknown entities
and maintain appropriate security on computers and electronic devices.
If applicant is an attorney, provide name of client you represent: _________________________________________________,
client's relationship to registrant: _____________________________, and your bar/professional license #:_______________.
Information for Birth Search
Full Name on Birth Record: _____________________________________________________________________________
Sex: ________ Date of Birth: ____________________ City/County: ____________________________________________
Mother’s / Parent’s Full Name Prior to First Marriage: _________________________________________________________
Father’s / Parent’s Full Name Prior to First Marriage: __________________________________________________________
Ordering Information (Definitions on Reverse Side)
Normal processing time for computer certification is 3-5 business days. Amended records require additional processing time.
Fee Quantity
Computer-Generated Certification of Birth: $9.00 first computer certification
X
=
Additional Computer Certification of Birth: $4.00 each additional computer certification
X
=
Photocopy-generated certificates require additional processing time.
Fee Quantity
Photocopy-Generated Certificate of Live Birth: $14.00 first photocopy certificate
X
=
Additional Photocopy Certificate of Live Birth: $4.00 each additional photocopy certificate
X
=
Fee Quantity
Additional Years Searched: $2.00 per year
(Required when exact year is unknown. Maximum fee is $50.00)
X
Rush Order (Optional): Rush orders are given priority processing and requires an additional
$10 fee. Mark the outside of your envelope “RUSH”. Expedite shipping is NOT included.
X
=
Shipping & Handling Fee per application (Standard U.S. Postal Delivery)
X
=
APPLICANT’S VALID PHOTO IDENTIFICATION REQUIRED
(See reverse side for additional information and eligibility requirements)
Total Amount Enclosed
$0.00
$10.00
$0.00
$0.00
$0.00
$0.00
$14.00
$0.00
$9.00
$1.00
$4.00
$4.00
$2.00
Print
Clear All
Clear Search Info
$1.00
1
$1.00
DH 726, 01/2022, Florida Administrative Code Rule 64V-1.0131 (Obsoletes Previous Editions)
INFORMATION AND INSTRUCTIONS FOR FLORIDA BIRTH CERTIFICATE APPLICATION
If you need assistance, please contact our Vital Records Section at 904-359-6900 ext. 9000.
A $9 search fee is included in all orders and is non-refundable. If no record is found, a certified “No Record Found”
statement will be issued. Application must include signature of eligible applicant.
COMPUTER-GENERATED CERTIFICATION OF BIRTH: Computer-generated certification of birth printed on security paper with the Florida embossed
seal, which is accepted by all state and federal agencies. Computer certifications are available from 1850 to present; but are limited from 1850-1916. A Computer
certification has two different formats based on the year of birth:
• 2004 to Present includes: Registrant (name on the record), Date of Birth, Sex, Time, Weight, Place of Birth (City/County); and Parent(s) Name, DOB,
Place of Birth.
• 1850 to 2003 includes: Registrant (name on the record), Date of Birth, Sex, County of Birth and Parent(s) Name.
PHOTOCOPY-GENERATED CERTIFICATE OF LIVE BIRTH: Photocopy-generated certificate of live birth manually produced from the original
record on file and printed on security paper with the Florida embossed seal, which is accepted by all state and federal agencies. Photocopy certificates require
additional processing time. The information collected at the time of birth varies based on the filing requirements at that time. Time of Birth was not collected on
birth events between 1949 -1969.
AVAILABILITY: Birth registration was not required by state law until 1917, but there are some records on file dating back to 1850. Birth records under seal by
reason of adoption, paternity determination or court order cannot be ordered in this manner.
ELIGIBILITY (Section 382.025, Florida Statutes): Birth certificates less than 125 years old can only be issued to:
1. Registrant (name 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 (must provide documentation)
5. Other person(s) by court order (must provide certified copy of court order)
6. Upon receipt of registrant’s death record, a birth certificate marked “Deceased” may be issued to registrant’s spouse, child, grandchild,
sibling, if of legal age (18). Please notate “Registrant Deceased” on the application and include a photocopy of the death certificate.
If applicant is not one of the above, the application must be accompanied with a notarized Affidavit to Release a Birth Certificate form (DH 1958) signed
by an eligible person (form is available on our website) and a copy of valid photo identification of both, the person authorizing release and the applicant.
REQUIREMENT FOR ORDERING: Eligible applicant must provide a completed application, a copy of a valid photo identification, and any
documentation required for proof of eligibility.
ACCEPTABLE FORMS OF IDENTIFICATION: Driver License, State Identification Card, Passport, Military Identification Card. For mail-in
requests, include a copy of the front and back of the ID. A foreign issued driver license, identification card, consular card, or Matricula card require two
additional forms of identification, such as a vehicle title or registration, health insurance card, employment ID, school ID, tax document, or mail with
current address.
FEES: Check or Money Order Payable to: Vital Statistics. DO NOT SEND CASH. International payments must be made by Cashier’s Check or Money
Order in U.S. Dollars drawn upon a U.S. Bank. Florida Law imposes an additional service charge of $15.00 for dishonored checks. Fees are nonrefundable,
except fees paid for additional copies when no record is found. These are refunded on written request.
OPTIONS FOR ORDERING:
CREDIT CARDS: The Bureau of Vital Statistics office currently does not accept credit cards by phone or mail, if you wish to order by credit card, you may
contact VitalChek, our only approved vendor. VitalChek charges an additional processing fee of $7.00 in addition a $10.00 Rush Fee charged by the Bureau of Vital
Statistics. Expedite shipping is available for an additional fee. VitalChek may be reached by telephone at 1-877-550-7330, by fax at 1-877-550-7428, or online at
VitalChek.com.
MAIL IN: Normal processing time is 3-5 business days for computer certifications. Photocopy certificates require additional processing time. If requesting
rush service mark the outside of your envelope “RUSH”. Rush orders are given priority processing. Expedite shipping is NOT included in rush fee. All orders
require a $1.00 Shipping and Handling Fee and are mailed Standard U.S. Postal delivery unless a special prepaid express delivery envelope is provided.
Records that have been previously amended require additional processing time.
WALK-IN SERVICE: Visit 1217 North Pearl Street, Jacksonville, Florida, between 8:00 am – 4:30 pm. Eligible applicants must present a valid ID when
requesting confidential records. Photocopy certificates require the $10 rush fee and may not be available for same day service.
MAIL THIS APPLICATION WITH PAYMENT AND COPY OF VALID ID TO:
FLORIDA DEPARTMENT OF HEALTH
BUREAU OF VITAL STATISTICS
ATTN: VITAL RECORDS SECTION
P.O. BOX 210, JACKSONVILLE, FL 32231-0042
Express Mail and Courier Deliveries to: 1217 North Pearl Street, Jacksonville, Florida, 32202
PLEASE VISIT OUR WEBSITE:
www.floridahealth.gov/certificates
