Birth/Death Certificate Information Short Form A bstract Birth Certificate This format satisfies most purposes, including registering a child for school or sports and obtaining a driver license in most states. The Abstract format of the Birth Certificate is available for all Texas Birth regardless of County. This certificate MAY NOT be accepted by the U.S. Passport Office as a valid birth certificate. Long Form Birth Certificate Used most often to obtain a passport. It's also typically required for purposes of dual citizenship and immigration. This format is not available for the City of Dallas. Qualified Applicants Self Paren t Spouse Grandparent Sibling Child Legal Guardian (Must provide certified copy of legal documentation ) Third Party: Notarized letter & copy of valid ID from immediate family member to release Birth/Death document More information can be found online @ www.DallasCounty.org Long Form Birth Certificates & Death Certificates AVAILA BLE for the following DALLAS COUNTY CITIES Addison Coppell Glenn Heights Lancaster Sachse Balch Springs Desoto Grand Prairie (96 to Present) Las Colinas Seagoville Carrollton (96 to Present) Duncanville Highland Park Mesquite Sunnyvale Cedar Hill Farmers Branch Hutchins Richardson (96 to Present) University Park Cockrell Hill Garland Irving Rowlett Wilmer /Wylie If City of Dallas (April 1983 to Present)Bureau of Vital Statistics Dallas, TX 75201 Mon-Fri 8:30am-4:30pm (214) 670-3 Long Forms Birth & Death Certificates NOT AVAILA BLE for the City of Dallas or other counties (see sides for contact information) . Order all Texas Records (1903 to Present)Austin Vitals Statistics 1100 W. 49th StAustin, TX 78756 Mon-Fri 8am - 5pm 1 - (888) 963 7111 www.Texas.gov Baylor Dallas Medical Center Methodist Medical Center Charlton Methodist Hospital Parkland Memorial Hospital Presbyterian of Dallas Dallas Veterans Affairs Medical Renaissance Hospital Dallas Doctors Hospital St. Paul Medical Center Lakepoint Hospital (Rowlett County ) Medical City Dallas Trinity Medical ( None Before - 1996) UT Southwestern ROUTINE SERVICE EXPEDITE SERVICE W e are processing routine a pplications in approximately 2 - 3 wee ks from the time application is submitted to us by mail. Mail your request by Overnight M ail Service and with enclosed paid Overnight Mail Envelope to expedite your request. May be mailed by FEDEX, UPS, or USPS Express mail . 2 - 5 business day service. Office of John F. Warren County Clerk Dallas County, Texas www.DallasCounty.org (214) 653 - 7099 Mail the following Items Mailing Address Form Completed and Signed Notarized Copy of ID Money Order Payable to: Dallas County Clerk (Printed no more than 60 days) Optional: Self Addressed Pre - postage Envelope (Certified, Priority, Express , Etc.) ATTN: Birth/Death Certificate Dallas, TX 752 County of Dallas Texas County of Dallas Texas County of Dallas Texas American LegalNet, Inc. www.FormsWorkFlow.com PART I. ENTER NAME, DATE AND PLACE OF , AND NAMES OF PARENTS AS INFORMATION APPEARS ON DEATH FULL NAME OF DATE OF PLACE OF DEATH (City SEX FULL NAME OF FULL PART III. Signature of Notary Public Commission Expires Typed or Printed Name Street Address PART II. MAIL THIS AND A PHOTOCOPY OF YOUR VALID PHOTO ID VS-142.3 Rev. Before me on this day appeared WARNING: IT IS A FELONY TO FALSIFY INFORMATION ON THIS DOCUMENT. THE PENALTY FOR KNOWINGLY MAKING A FALSE STATEMENT ON THIS FORM OR FOR SIGNING A FORM WHICH CONTAINS A FALSE STATEMENT IS 2 TO 10 YEARS IMPRISONMENT AND A FINE OF UP TO $10,000. (HEALTH AND SAFETY CODE, CHAPTER 195, SEC. 195.003) American LegalNet, Inc. www.FormsWorkFlow.com Death Certificate Death Certif i cate D a ll a s C o un t y S u b urbs O n l y $21 1 st c o p y A dd it i on a l C opies a r e $ 4 O f D ea t h C e r t i f i c a t e Not a v a il ab l e for C i t y of D a l l as $4 eac h Of f ice U s e On l y A pplicant In f ormat i on [ ] I D # [ ] Passport Ex p i r e Da t e Other: S t a t e of I s s u e C le r k A mount [ ] Doc um e n t s Ve r i f i ed Y ear B oo k Page R eceipt S ec u ri t y Office of John F . W arr en Cou n ty C l erk D a l l as C o unt y , Texas www.D a ll a s Coun ty . org Application for Certified Copy Birth or Death Certificate Birth Certificate Short Form ( A b s t r act) A v a il a ble for all T ex a s b i r t hs $23 .03 each L ong Form D a ll a s C o un t y S u b urbs O n l y Not a v a il ab l e for C i t y of D a l l as $23 .03 each C a s h, Money O r de r , or Debi t / Cred i t A cc e p t e d ( $ 3 . 9 5 co n venie n ce f ee a ppl i es for ca r d pa y m ent s ) . For any sea r ch of t h e fi l es w he r e a re c ord is not f o und, the s ea r c h ing f e e is not re f undable o r tran s f e r abl e . B IRT H /D E A T H R E CO R D INF OR M A TION (In f o r m ation d e ce r tifi c a d o ) N a me on Reco r d : (N o mb r e) Fi r s t n a m e /P r i m er n o m b r e M idd l e / Seg un do n o m b r e La s t Na m e / A p p e llido Da t e of Bi r t h : ( F e c ha n a c i m ie n t o) Pl a ce of Bi r t h /Deat h : M o n t h / M es D a y / Dia Y e a r / A 361 o Da t e of De a t h : ( D e s f un c i o n ) M o n t h / M es D a y / Dia Y e a r / A 361 o TEX A S O N LY (Lu g ar n a c i m i e n t o ) H o sp it a l n a m e : Ci t y / C u idad de n acia m e n t o Co u n t y / Co n dado de n acia m e n t o S t a te / Estado de n acia m e n t o N o Long Form B ir t h C er t ific a t e s for t he C i t y of Da ll a s ( O n ly A b s t r a c t ) No De a th C e r tifica t es a r e a v a i l ab le for De a t h s t ha t occu rr ed in t h e C ity of Dal la s (Ho s p i ta l ) P a r ent 1 : [ ] M o t her [ ] Fa t her * V i e w l i st on b a c k for a v a il ab i l i t y (No of r e c e mos fo r ma l ar g a y a c t as d e sfun c t i on p ara l a Cu i d a d d e D a l l as) [ ] M a dre [ ] P ad r e Fi r s t /P r i m er n o m b r e M idd l e / Seg un do n o m b r e M aiden or L as t N am e / A p e llido A n t er ior P a r ent 2 : [ ] M o t her [ ] Fa t her [ ] M a dre [ ] P ad r e Fi r s t /P r i m er n o m b r e M idd l e / Seg un do n o m b r e M aiden or La s t Na m e / A p e llido Y O UR INF O R MA T ION (I nfo r m at i on d e s olic i ta n te) Pu r p o s e f or r eq u e s t: [ ] P a ss p o r t [ ] Re c o rd s [ ] Sch o ol R e lat i o n t o : [ ] Self [ ] F a t h er [ ] Spou s e [ ] L eg a l G ua r d i a n [ ] M other [ ] Sib l i n g [ ] C h i ld [ ] G r a n dpa r ent [ ] D r iver L i c en s e [ ] Hou s i n g [ ] T r a vel [ ] Vete ra n [ ] Social S e cu r ity [ ] In s u r a nce O t h e r : Your N a m e : (N o mb r e) Fi r s t /P r i m er n o m b r e de so l ic i t a n t e M idd l e / Seg un do n o m b r e La s t Na m e / A p p e llido Ho m e add r e s s : (D o m i c i l i o) # S t r e e t / Calle A p t # Ci t y / Ci u dad S t a te / Estado Z i p C ode / Cod i go Pho n e #: ( Te l ef o no) ( ) E - ma i l: ( F o r R ece i p t ) [ ] S A M E A S A B O VE Ma il i ng add r e s s : ( R e s i d e n c i a de d o m i c i li o e s d i f e r e n t e) Fi r s t /P r i m er n o m b r e de so l ic i t a n t e M idd l e / Seg un do n o m b r e La s t Na m e / A p p e llido # S t r e e t / C a l l e A p t # Ci t y / Ci u dad S t a t e / E s t ado Z i p C od e / Co d i go ( M u s t s i g n to p r oce s s ) Da t e W A R N I N G : IT I S A FE L O NY TO FA L S IFY I NF O R M ATI O N O N T H I S DO C UM E NT. T H E P E NA L T Y F O R KN O W IN G L Y M A KI NG A FA L SE ST A TE M E N T O N T HIS F O RM O R F O R SI G N I NG A F O RM W H I C H C O NT A I N S A F A L SE S T ATE M E NT IS 2 TO 1 0 Y E A R S I M P R IS O N M E NT A ND A F I N E U P TO $ 1 0 ,0 0 0 . (H E A L T H A N D S AFE T Y C O DE, C H AP T ER 1 9 5 , S EC 1 9 5 .0 0 3 ) W o u ld y o u like a receipt em a iled? Y es [ ] N o [ ] W o u ld y o u like a paper r eceip t ? Y es [ ] N o [ ] F orm r e v i s e d 07/20 / 20 1 6 D C C Y W American LegalNet, Inc. www.FormsWorkFlow.com