RD-225
MOD 12/08
COMMONWEALTH OF PUERTO RICO
DEPARTMENT OF HEALTH
DEMOGRAPHIC REGISTRY
BIRTH CERTIFICATE APPLICATION BY MAIL
PART I: REGISTRANT’S INFORMATION
1. Name at birth:
________________
Father’s Last Name
Mother’s Last Name
First Name
Middle Name
3. Place of birth: (town and hospital)
2. Date of birth: (month/date/year)
4.Father’s Name:
5. Mother’s Name:
6. The certificate will be used for:
7. Number of copies:
Part II: APPLICANT’S INFORMATION*
2. Relationship:**
1.Applicant’s Name:
Father’s Last Name Mother’s Last Name First Name Middle Name
3. Applicant’s address:
4. Address where you want the certificate to be sent:
5. Applicant’s identification included:
Other
6. Applicant’s signature and date:
___Driver’s Lic, ___State ID, ___Passport, ___Public
Assistance, ___ Other
IMPORTANT: FIRST COPY $5.00 EACH / ADDITIONAL COPY $4.00 OF SAME PERSON
1.
Applicants living out of Puerto Rico send the application to the following address: Demographic Registry PO Box 11854,
San Juan Puerto Rico 00910
2.
If the applicant lives in Puerto Rico can visit any Local Registry near his/her house to complete an application.
3.
Applicant must send a photocopy of a recent valid photo-identification card.
4.
Applicant in Puerto Rico: Please send $5:00 internal Revenue Stamp for the first copy requested and $4.00 for each
additional copy for the same person.
5.
Applicant out of Puerto Rico: Please send $5.00 Money Order payable to Secretary of the Treasury.
6.
Please send a self-addressed-stamped-envelope to mail in your certificate.
7.
For rush mail as Fedex, Exp. Mail, Registered, UPS, etc. our address is: 171 Quisqueya Street, Hato Rey, PR 00917
WRITE CLEARLY YOUR NAME AND ADDRESS
*Applicant – means registrant, their children over 18 years of age, legal representative.
**Relationship – relation between the applicant and the registrant. This blank will be filled out if applicant and
Registrant is not the same person.
RD-225
MOD 12/08
COMMONWEALTH OF PUERTO RICO
DEPARTMENT OF HEALTH
DEMOGRAPHIC REGISTRY
BIRTH CERTIFICATE APPLICATION BY MAIL
PART I: REGISTRANT’S INFORMATION
1. Name at birth:
________________
Father’s Last Name
Mother’s Last Name
First Name
Middle Name
3. Place of birth: (town and hospital)
2. Date of birth: (month/date/year)
4.Father’s Name:
5. Mother’s Name:
6. The certificate will be used for:
7. Number of copies:
Part II: APPLICANT’S INFORMATION*
2. Relationship:**
1.Applicant’s Name:
Father’s Last Name Mother’s Last Name First Name Middle Name
3. Applicant’s address:
4. Address where you want the certificate to be sent:
5. Applicant’s identification included:
Other
6. Applicant’s signature and date:
___Driver’s Lic, ___State ID, ___Passport, ___Public
Assistance, ___ Other
IMPORTANT: FIRST COPY $5.00 EACH / ADDITIONAL COPY $4.00 OF SAME PERSON
1.
Applicants living out of Puerto Rico send the application to the following address: Demographic Registry PO Box 11854,
San Juan Puerto Rico 00910
2.
If the applicant lives in Puerto Rico can visit any Local Registry near his/her house to complete an application.
3.
Applicant must send a photocopy of a recent valid photo-identification card.
4.
Applicant in Puerto Rico: Please send $5:00 internal Revenue Stamp for the first copy requested and $4.00 for each
additional copy for the same person.
5.
Applicant out of Puerto Rico: Please send $5.00 Money Order payable to Secretary of the Treasury.
6.
Please send a self-addressed-stamped-envelope to mail in your certificate.
7.
For rush mail as Fedex, Exp. Mail, Registered, UPS, etc. our address is: 171 Quisqueya Street, Hato Rey, PR 00917
WRITE CLEARLY YOUR NAME AND ADDRESS
*Applicant – means registrant, their children over 18 years of age, legal representative.
**Relationship – relation between the applicant and the registrant. This blank will be filled out if applicant and
Registrant is not the same person.
