Texas Birth Certificate Application Form - City of McAllen, Texas

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City of McAllen
TEXAS BIRTH CERTIFICATE APPLICATION
VITAL STATISTICS
VOIDS_____________ Copy # ___________________
P.O. BOX 220
(956) 681-1195
VOIDS_____________ Card # ____________________
McAllen, Texas 78505
Date_____________________________________
Please complete all questions and sign application
: _________________________________________________________
Full Name of Person on Record
: _________________________________________________
Date of Birth
Sex { } Male { } Female
Month
/
Day
/
Year
________________________________________________________
Place of Birth (City / Hospital):
: _______________________________________________________________
Full Name of Father
: _________________________________________________________
Mother’s full Maiden Name
What is YOUR relationship to the person whose certificate you want: (check one)
{ } Parent
must be listed on certificate
(Current US Government issued picture ID* required (not a copy))
{ } Self - must be at least 18 years of age or if a minor, certified copy of marriage license required
(Current
US Government issued picture ID* required (not a copy))
{ } Grandparent
AND
(Proof required: Your son or daughter’s certified birth certificate (not a copy)
YOUR current US
Government issued picture ID*)
{ } Spouse
AND
(Proof required: Certified Copy of Marriage License
current US Government issued picture ID*)
(not a copy)
{ } Brother/Sister – must be at least 18 years of age
(Proof required: Must provide your own certified birth
AND
certificate for verification
US Government issued picture ID*)
( ) Legal Guardian (
Proof required: Court order signed by a US Judge showing legal custody and your own current US
Government issued picture ID*)
Only those listed above are qualified applicants
$23.00 each
Check which certificate you are requesting: { } Certified Copy – Full Sheet - only for those born in McAllen
and/or
Note: If NO RECORD is found, a searching
Fee of $23.00 will be charged. And if both
$23.00 each
{ }
– If born anywhere in the State of Texas
*Abstract (1/2 sheet)
Certificates are checked off, both will be
*
Abstract available only if names fit
including McAllen
Charged – NO EXCEPTIONS.
Plastic Pouch @ $1.50 each (optional)
PLEASE INDICATE IF THERE HAS BEEN A CHANGE OR CORRECTION ON THE RECORD { } Yes { } No
My purpose to obtain this record is: ________________________________________________________
Indicate What Valid (CURRENT) photo Identification you will present of yourself (REQUIRED):
( ) US Drivers License*
( ) US State Issued ID*
( ) US Passport*
( ) Resident Alien* ( ) Border Crosser*
PLEASE FILL OUT THE FOLLOWING WITH YOUR INFORMATION:
*additional documentation may be needed
Name:
________________________________________________________________________________
Current Physical Address:
_____________________________________________________________
City/State/Zip Code:
___________________________________________________________________
Phone No:
_____________________________________________________________________________
Your Date of Birth as shown on your ID:
_______________________________________________
WARNING: The penalty for knowingly making a false statement on this form can be 2-10 years in prison and a fine of up to
$10,000 (Health and Safety Code, Chapter 195, Sec. 195.003.)
Signature: ______________________________________________________Date:_______________________
NOTE: If you will be mailing in this application to us from outside the RGV but within the USA, you will need to attach a COPY
of both sides of your identification such as one of those indicated above that is not expired along with other required documents,
and a Money Order for our fee (we do not take personal checks for payment on mail requests)&a self-addressed envelope. For
FED EX or UPS ONLY please send to 221 S. 15th, McAllen TX 78501. For Regular, Priority & Express Mail through the US
Postal Service send to P.O. Box 220 McAllen, Texas 78505. We mail requested document back to applicant in an express manner
ONLY through the US Postal Service-a prepaid & self-addressed envelope must be sent along with request. No calling for pick-up
will be done by our office to any shipping service. WE ONLY ACCEPT MAIL REQUESTS FOR THOSE BORN IN McALLEN -
WE DO NOT ACCEPT REQUESTS FROM OTHER COUNTRIES NOR MAIL CERTIFICATES OUT OF THE USA.
City of McAllen
TEXAS BIRTH CERTIFICATE APPLICATION
VITAL STATISTICS
VOIDS_____________ Copy # ___________________
P.O. BOX 220
(956) 681-1195
VOIDS_____________ Card # ____________________
McAllen, Texas 78505
Date_____________________________________
Please complete all questions and sign application
: _________________________________________________________
Full Name of Person on Record
: _________________________________________________
Date of Birth
Sex { } Male { } Female
Month
/
Day
/
Year
________________________________________________________
Place of Birth (City / Hospital):
: _______________________________________________________________
Full Name of Father
: _________________________________________________________
Mother’s full Maiden Name
What is YOUR relationship to the person whose certificate you want: (check one)
{ } Parent
must be listed on certificate
(Current US Government issued picture ID* required (not a copy))
{ } Self - must be at least 18 years of age or if a minor, certified copy of marriage license required
(Current
US Government issued picture ID* required (not a copy))
{ } Grandparent
AND
(Proof required: Your son or daughter’s certified birth certificate (not a copy)
YOUR current US
Government issued picture ID*)
{ } Spouse
AND
(Proof required: Certified Copy of Marriage License
current US Government issued picture ID*)
(not a copy)
{ } Brother/Sister – must be at least 18 years of age
(Proof required: Must provide your own certified birth
AND
certificate for verification
US Government issued picture ID*)
( ) Legal Guardian (
Proof required: Court order signed by a US Judge showing legal custody and your own current US
Government issued picture ID*)
Only those listed above are qualified applicants
$23.00 each
Check which certificate you are requesting: { } Certified Copy – Full Sheet - only for those born in McAllen
and/or
Note: If NO RECORD is found, a searching
Fee of $23.00 will be charged. And if both
$23.00 each
{ }
– If born anywhere in the State of Texas
*Abstract (1/2 sheet)
Certificates are checked off, both will be
*
Abstract available only if names fit
including McAllen
Charged – NO EXCEPTIONS.
Plastic Pouch @ $1.50 each (optional)
PLEASE INDICATE IF THERE HAS BEEN A CHANGE OR CORRECTION ON THE RECORD { } Yes { } No
My purpose to obtain this record is: ________________________________________________________
Indicate What Valid (CURRENT) photo Identification you will present of yourself (REQUIRED):
( ) US Drivers License*
( ) US State Issued ID*
( ) US Passport*
( ) Resident Alien* ( ) Border Crosser*
PLEASE FILL OUT THE FOLLOWING WITH YOUR INFORMATION:
*additional documentation may be needed
Name:
________________________________________________________________________________
Current Physical Address:
_____________________________________________________________
City/State/Zip Code:
___________________________________________________________________
Phone No:
_____________________________________________________________________________
Your Date of Birth as shown on your ID:
_______________________________________________
WARNING: The penalty for knowingly making a false statement on this form can be 2-10 years in prison and a fine of up to
$10,000 (Health and Safety Code, Chapter 195, Sec. 195.003.)
Signature: ______________________________________________________Date:_______________________
NOTE: If you will be mailing in this application to us from outside the RGV but within the USA, you will need to attach a COPY
of both sides of your identification such as one of those indicated above that is not expired along with other required documents,
and a Money Order for our fee (we do not take personal checks for payment on mail requests)&a self-addressed envelope. For
FED EX or UPS ONLY please send to 221 S. 15th, McAllen TX 78501. For Regular, Priority & Express Mail through the US
Postal Service send to P.O. Box 220 McAllen, Texas 78505. We mail requested document back to applicant in an express manner
ONLY through the US Postal Service-a prepaid & self-addressed envelope must be sent along with request. No calling for pick-up
will be done by our office to any shipping service. WE ONLY ACCEPT MAIL REQUESTS FOR THOSE BORN IN McALLEN -
WE DO NOT ACCEPT REQUESTS FROM OTHER COUNTRIES NOR MAIL CERTIFICATES OUT OF THE USA.

Download Texas Birth Certificate Application Form - City of McAllen, Texas

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