Form ADPH-HS-75 "Application to Add Father to Child's Alabama Birth Certificate" - Alabama

What Is Form ADPH-HS-75?

This is a legal form that was released by the Alabama Department of Public Health - a government authority operating within Alabama. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2019;
  • The latest edition provided by the Alabama Department of Public Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form ADPH-HS-75 by clicking the link below or browse more documents and templates provided by the Alabama Department of Public Health.

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Download Form ADPH-HS-75 "Application to Add Father to Child's Alabama Birth Certificate" - Alabama

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APPLICATION TO ADD FATHER TO CHILD’S ALABAMA BIRTH CERTIFICATE
Please complete this form to add the father’s information to the birth certificate of the child listed below. Before we begin to process your
request, additional information, valid identification (see reverse side) and/or documents are needed. Please answer the following questions
and provide the documents as indicated when you return this form. After reviewing the information you provide, we will advise you if other
documents will be required or if a court action is needed. If you are not a parent of the child or if you do not have legal custody of the child, we
may not be able to process your request.
The fee to prepare the new birth certificate is $25.00 which includes one certified copy of the new birth certificate. Additional copies of the same
record ordered at the same time are $6.00 each. There is an additional fee of $15.00 to expedite a request. Make check or money order
payable to “State Board of Health.” Do not send cash. Fees are not refundable if the action cannot be completed due to non-receipt of the
required documents. However, we will return the fee if we determine you are not legally authorized to make the request.
INFORMATION ON APPLICANT
(THIS SECTION MUST BE COMPLETED) Valid identification must be submitted with a request to change a
birth certificate. Anyone falsely applying for a record is subject to a penalty upon conviction of up to three months in the county jail or a fine of up
to $500. (Code of Alabama 1975, § 13A-10-109).
By signing, you are certifying you have a legal right to the record requested.
Your Signature _______________________________________________________ Date ______________________________________
Print Your Name _________________________________________ Number of Copies ___________ Amount Enclosed $ _____________
Your Relationship to Child _________________________________________________________________________________________
Mail to Name (if Different from You) _________________________________________________________________________________
Mailing Address _________________________________________________________________________________________________
City _______________________________ State ________ Zip ________________ Daytime Phone (_____
) ______________________
I allow the following individual to receive the certificate(s) ________________________________________________________________
INFORMATION TO LOCATE CHILD’S BIRTH CERTIFICATE
CHILD’S FULL NAME AS SHOWN ON BIRTH CERTIFICATE ____________________________________________________________
First
Middle
Last
CHILD’S DATE OF BIRTH _____________________________ CHILD’S COUNTY OF BIRTH
________________________________________
MOTHER’S FULL NAME BEFORE FIRST MARRIAGE
___________________________________________________________________________
MOTHER’S LEGAL NAME AT TIME OF BIRTH
__________________________________________________________________________________
INFORMATION REGARDING CHILD’S PARENTAGE
1. Do you want the father’s name added to the child’s birth certificate?
_______Yes _______No
2. Do you want to change the child’s name on the birth certificate when you add the
father’s name?
_______Yes _______No
3. Was the mother married to anyone at the time of the child’s birth, or within 300 days
before the child’s birth?
_______Yes _______No
4. Have the father and mother married since the child was born?
If Yes, send a certified copy of the marriage certificate.
_______Yes _______No
5. Has an individual ever claimed to be the father of this child in court?
If Yes, send a certified copy of the court order.
_______Yes _______No
6. Has the child support court or any other type of court ever declared an individual to
be the father of this child? If Yes, send a certified copy of the court order.
_______Yes _______No
7. Has a court established legal custody for this child?
If Yes, send a certified copy of the custody order.
_______Yes _______No
8. What is the father’s name, date of birth and state of birth?
Father’s Name _________________________________________Father’s Date of Birth ________________ Father’s State of Birth _______
MAIL THIS COMPLETED FORM WITH VALID IDENTIFICATION AND APPROPRIATE FEE TO:
Center for Health Statistics
Attn: Legitimations
P. O. Box 5625
Montgomery, Alabama 36103-5625
If you have any questions, call 334.206.2637. Visit our website at: www.alabamapublichealth.gov/vitalrecords.
ADPH-HS-75/Rev. 05/01/2019
APPLICATION TO ADD FATHER TO CHILD’S ALABAMA BIRTH CERTIFICATE
Please complete this form to add the father’s information to the birth certificate of the child listed below. Before we begin to process your
request, additional information, valid identification (see reverse side) and/or documents are needed. Please answer the following questions
and provide the documents as indicated when you return this form. After reviewing the information you provide, we will advise you if other
documents will be required or if a court action is needed. If you are not a parent of the child or if you do not have legal custody of the child, we
may not be able to process your request.
The fee to prepare the new birth certificate is $25.00 which includes one certified copy of the new birth certificate. Additional copies of the same
record ordered at the same time are $6.00 each. There is an additional fee of $15.00 to expedite a request. Make check or money order
payable to “State Board of Health.” Do not send cash. Fees are not refundable if the action cannot be completed due to non-receipt of the
required documents. However, we will return the fee if we determine you are not legally authorized to make the request.
INFORMATION ON APPLICANT
(THIS SECTION MUST BE COMPLETED) Valid identification must be submitted with a request to change a
birth certificate. Anyone falsely applying for a record is subject to a penalty upon conviction of up to three months in the county jail or a fine of up
to $500. (Code of Alabama 1975, § 13A-10-109).
By signing, you are certifying you have a legal right to the record requested.
Your Signature _______________________________________________________ Date ______________________________________
Print Your Name _________________________________________ Number of Copies ___________ Amount Enclosed $ _____________
Your Relationship to Child _________________________________________________________________________________________
Mail to Name (if Different from You) _________________________________________________________________________________
Mailing Address _________________________________________________________________________________________________
City _______________________________ State ________ Zip ________________ Daytime Phone (_____
) ______________________
I allow the following individual to receive the certificate(s) ________________________________________________________________
INFORMATION TO LOCATE CHILD’S BIRTH CERTIFICATE
CHILD’S FULL NAME AS SHOWN ON BIRTH CERTIFICATE ____________________________________________________________
First
Middle
Last
CHILD’S DATE OF BIRTH _____________________________ CHILD’S COUNTY OF BIRTH
________________________________________
MOTHER’S FULL NAME BEFORE FIRST MARRIAGE
___________________________________________________________________________
MOTHER’S LEGAL NAME AT TIME OF BIRTH
__________________________________________________________________________________
INFORMATION REGARDING CHILD’S PARENTAGE
1. Do you want the father’s name added to the child’s birth certificate?
_______Yes _______No
2. Do you want to change the child’s name on the birth certificate when you add the
father’s name?
_______Yes _______No
3. Was the mother married to anyone at the time of the child’s birth, or within 300 days
before the child’s birth?
_______Yes _______No
4. Have the father and mother married since the child was born?
If Yes, send a certified copy of the marriage certificate.
_______Yes _______No
5. Has an individual ever claimed to be the father of this child in court?
If Yes, send a certified copy of the court order.
_______Yes _______No
6. Has the child support court or any other type of court ever declared an individual to
be the father of this child? If Yes, send a certified copy of the court order.
_______Yes _______No
7. Has a court established legal custody for this child?
If Yes, send a certified copy of the custody order.
_______Yes _______No
8. What is the father’s name, date of birth and state of birth?
Father’s Name _________________________________________Father’s Date of Birth ________________ Father’s State of Birth _______
MAIL THIS COMPLETED FORM WITH VALID IDENTIFICATION AND APPROPRIATE FEE TO:
Center for Health Statistics
Attn: Legitimations
P. O. Box 5625
Montgomery, Alabama 36103-5625
If you have any questions, call 334.206.2637. Visit our website at: www.alabamapublichealth.gov/vitalrecords.
ADPH-HS-75/Rev. 05/01/2019
IDENTIFICATION REQUIREMENTS FOR RESTRICTED ALABAMA VITAL RECORDS
Identification is required of any applicant requesting a restricted Alabama vital record (birth certificate
less than 125 years from the date of birth or death certificate less than 25 years from the date of death). The
applicant must submit a completed request and one form of identification from the Primary ID list below. In
the event the applicant is unable to provide identification from the Primary ID list, he/she may provide two
different forms of identification from the Secondary ID list.
If the applicant designates another individual to pick up a restricted certificate on his/her behalf, both
the applicant and the designee must provide acceptable identification.
The completed request, as well as a copy of all identification submitted, will be maintained by the vital
records office which processes the request.
Primary IDs Including PHOTO
Secondary IDs
(need at least one, current, expired no more
(need at least two)
than 60 days)
Alabama Driver’s License
-
Out-of-State Driver’s License
-
-
Expired, Government-Issued ID
-
-
Utility Bill (No more than 6 months old)
State-Issued Non-Driver ID
-
-
Work ID (If applicant is making personal
U.S. or Foreign Passport
-
request)
U.S. Certificate of Naturalization
-
-
Vehicle Registration or Vehicle Title
Certificate of Citizenship
-
-
Property Tax Bill
U.S. Military ID
-
-
Military Discharge (DD Form 214)
Work ID (If applicant is employee of
-
agency/company making request)
Voter Registration Card
-
-
Alien Resident Card (Temporary or
Health Insurance Card
-
Permanent)
Social Security Correspondence (not
-
Card)
U.S. Employment Authorization Card
-
-
Citizenship ID Card
U.S. Selective Service Card
-
-
Tribal ID
Recent DMV Receipt for Fines Paid
Pilot’s License
-
-
Fishing or Hunting License
-
-
Boating License
Copy of Police Report or other official
-
Concealed Weapons License
documents which support theft, in cases
where individual’s ID has been stolen
-
Ex-Felon ID
-
-
Inmate ID issued by the U.S. Dept of
Autism Spectrum Card
-
Justice w/ following documentation:
Immunization (Shot) Record
o Supporting documents from
*In special cases where applicant is unable to
institution if inmate is still in
provide any of these documents, please contact
custody, letter of release from
CHS at 334.206.5418.
institution if inmate has been
released
-
School ID (Must include current school
term)
-
Alabama Voter Identification Card
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