Application for Birth Record
Application for Birth Record
Arlington Vital Records Office Arlington City Hall
101 W. Abram Street, 1st Floor Arlington, TX 76010
APPLICATIONS WITHOUT VALID PHOTO ID WILL NOT BE PROCESSED.
TEXAS BIRTHS ONLY APPLICATIONS MUST BE COMPLETELY FILLED OUT
These records are protected by the Texas Health and Safety Code and may only be released to a properly qualified applicant, which is defined as an immediate member of the family, a legal or personal representative, or agent. All information must be completed before your order can be processed.
Fees: $23.00 for each copy.
Long form # of copies: ____ Short form # of copies (Long form available for births in Arlington after 1971)
Protect your Vital Record with a Poly Envelope: $2.00 ____________
Full Name:
(Person on record)
First
Middle
Last
Date of birth:
Place of birth: City
County
State
Full Name of Father: First
Full MAIDEN Name of Mother: First
Middle Middle
Name of Applicant:
(Printed name of person signing the application)
Address of Applicant:
Street
City
Last Maiden Name Phone:
State
Zip
Relationship to Person Named on the record:
Purpose for Obtaining this Record:
Warning: The penalty for knowingly making a false statement on this form can be 2 to 10 years in prison and a fine of up to $10,000. (Health and Safety Code, Chapter 195.003)
Signature of Applicant
Date of Application
APPLICATIONS WITHOUT SIGNATURE OF APPLICANT WILL NOT BE PROCESSED.
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