Notification Of Order Of Parentage And Application For A New Birth Certificate
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Notification Of Order Of Parentage And Application For A New Birth Certificate Form. This is a Tennessee form and can be use in Shelby Local County.
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Tags: Notification Of Order Of Parentage And Application For A New Birth Certificate, Tennessee Local County, Shelby
TENNESSEE DEPARTMENT OF HEALTH
OFFICE OF VITAL RECORDS
NOTIFICATION OF ORDER OF PARENTAGE AND APPLICATION
FOR A NEW BIRTH CERTIFICATE
Tennessee Code Annotated Sections 36-2-313 and 68-3-310
Name of Court ___________________________________________________
Today’s Date _____________________
County of _________________________
City of _______________________
Docket Number ____________________
Date of Decree _________________
SECTION I
State of __________________________
INFORMATION CONCERNING CHILD
Name of Child Prior to Court Order ____________________________________________________________________
Social Security Number __________________________________________Date of Birth _________________________
Place of Birth _______________________________________________________
CITY
COUNTY
SECTION II
INFORMATION FOR NEW CERTIFICATE OF BIRTH
Name of Child _________________________ ________________________
As Determined by Court
First
Middle
Sex _________________________
STATE
_________________________________
Last
FATHER OF CHILD
MOTHER OF CHILD
Full Name
Full Legal Name
Date of Birth
Full Maiden Name
Birthplace
Date of Birth
STATE OR FOREIGN COUNTRY
Residential Address
City
Zip Code
Residential Address
State
City
Zip Code
Mailing Address (if different)
Mailing Address (if different)
Home Telephone Number
Home Telephone Number
Social Security Number
Social Security Number
Driver’s License Number
Driver’s License Number
Employer
Employer
Employer’s Address
Employer’s Address
Employer’s Telephone Number
Employer’s Telephone Number
Health Insurance
Health Insurance
Policy Number
State
Policy Number
INSTRUCTIONS
1. A new certificate of birth will be prepared in accordance with the law upon the completion and submission of this form
and a certified copy of the court’s order of parentage.
2. Enclose the $30.00 fee required for preparation and issuance of a new birth certificate. Make check payable to
Tennessee Vital Records.
3. Mail to:
Tennessee Vital Records
421 5th Avenue North
1st Floor, Central Services Bldg
Nashville, TN 37243
PH 3343 (rev. 11/2008)
RDA-1399
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