
A computer certification has two different formats:
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)
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).
APPLICANT’S SIGNATURE: Is required, as well as his/her printed name, residence address and telephone number.
COUNTY HEALTH DEPARTMENT NAME AND ADDRESS
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.
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.
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
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.
*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).
DH 1960, 04/2016, Florida Administrative Code Rule 64V-1.0131 (Obsoletes Previous Editions)
Revised 12/1/2021