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APPLICATION FOR FLORIDA BIRTH RECORD Florida …

APPLICATION FOR FLORIDA BIRTH RECORD FLORIDA Department of Health in Broward County vital Statistics Department 780 SW 24 Street, Ft. Lauderdale, FL 33315-2643 (954)-467-4413 Requirement for ordering: If applicant is self, parent, guardian, or legal representative, then the applicant must complete this APPLICATION and provide photo identification. If applicant is not one of the above, the Affidavit to Release A BIRTH Certificate must be completed by an authorized person and submitted in addition to this APPLICATION form, along with photo identification. Acceptable forms of identification are the following: Driver s License, State Identification Card, Passport, and/or Military Identification Card.

For a record under seal write to: State Office of Vital Statistics, Attn: Records Amendment Section, Post Office Box 210, Jacksonville, Florida 32231-0042. ELIGIBILITY: Birth certificates can be issued only to: 1)the registrant (the child named on the record) if of legal age (18) 4) a legal representative of one of these persons, or

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