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Notification Of Order Of Parentage And Application For A New Birth Certificate - Tennessee
| Notification Of Order Of Parentage And Application For A New Birth Certificate Form. This is a Tennessee form and can be used in Juvenile Court Shelby Local County . |
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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 ___________________________________________________ County of _________________________ Docket Number ____________________ SECTION I City of _______________________ Date of Decree _________________ Today's Date _____________________ 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 FATHER OF CHILD Full Name Date of Birth Birthplace STATE OR FOREIGN COUNTRY Residential Address Residential Address Full Legal Name Full Maiden Name Date of Birth Sex _________________________ STATE _________________________________ Last MOTHER OF CHILD City Zip Code Mailing Address (if different) Home Telephone Number Social Security Number Driver's License Number Employer Employer's Address Employer's Telephone Number Health Insurance Policy Number State City Zip Code Mailing Address (if different) Home Telephone Number Social Security Number Driver's License Number Employer Employer's Address Employer's Telephone Number Health Insurance Policy Number State 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 American LegalNet, Inc. www.FormsWorkFlow.com
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