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Application For Certified Copy Of Birth Or Death Certificate - Texas
| Application For Certified Copy Of Birth Or Death Certificate Form. This is a Texas form and can be used in General Denton Local County . |
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Vital Statistics 940/349-2018 Recording Department Metro 940/349-2010 NO PERSONAL CHECKS ACCEPTED ACCEPTED FORMS OF PAYMENT INCLUDE: By Mail: Money Order or Cashiers Check In Person:Cash or Credit CardjVisa not accepted Cynthia Mitchell County Clerk Denton County Courts Building 1450 E. McKinney, 1" Floor, Denton P.O. Box 2187, Denton, Texas 76202 Application for certified copy of BIRTH or DEATH Certificate BIRTH # OF CERTIFIED COPIES _ _.X Please Print All Information $23.00 (Each) = $_ __ Espanof en fa pagina siguiente DEATH FIRST CERTIFIED COPY - $ 21.00 X$4.00=$ _ _ # OF ADDITIONAL CERTIFIED COPIES OF SAME RECORD TOTAL ENCLOSED $ 1. Full Name of Person on Record 2. Date of Event First Name Middle Name Last Name Month Day Year 3. Sex 4. Place of Event City or Town County State 5. Full Name of Father 6. Full Maiden Name of Mother First Name Middle Name Last Name First Name Middle Name Last Name (Maiden) 7. Applicant's Name: _ _ _ _ _ _ _ _ _ _ _ _ _ __ 9. Mailing Address: 8. Phone Daytime: _ _ _ _ _ _ _ _ __ -----------------------------------ZIP Code City State 10. Relationship to Person in Item 1:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ 11. Purpose for obtaining this record.:....:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ WARNING: THE PENALTY FOR KNOWINGLY MAKING A FALSE STATEMENT IN 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 OF APPLICANT DATE NO PERSONAL CHECKS ACCEPTED Type ofldentification: (Photocopy Attached): ----------- Number: American LegalNet, Inc. www.FormsWorkFlow.com
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