Online Birth Certificate Request
Step 1, Please Enter All Information

This is an official online birth certificate request.

Please note the following:

    • The fee payment will be paid through Permitium Payments. The charge will show on your credit card statement as 'PermVitalRecs'
    • PLEASE NOTE: If you are requesting documents to be delivered by MAIL, you will be asked some security questions AFTER THE PAYMENT SECTION HAS BEEN COMPLETED. You MUST complete this section.

Attention:


The State Office is requiring that all applicants upload a form of identification when submitting their application. Click on the button below for information on the forms of identification acceptable.


Click here for list of forms of identification

Please Enter The Full Name On The Birth Certificate:


Information Related To Birth:

You have selected an area that may be outside of our registration district. This could result in a certified birth fact (abstract certified birth certificate). Although this is a legal document, please STOP and check with the entity requesting the record to ensure their acceptance. By entering your birth city below, you acknowledge that you may receive a birth fact and will be charged accordingly.


Parent Names As Listed on Birth Certificate:


Please Enter The Requestor's Name:



Requestor's Current Residence Address: (this may be different than the mailing address)


Requestor's Current Mailing Address: (if different from residence address)


Requestor's Contact Telephone Numbers: (###-###-####)


Requestor's Driver's License: (or other State Issued ID)


Requestor's Email:


Please Create A Password: (you can use this to track progress, and we may need to contact you during the process)


Please attach your photo identification

  I will mail these documents. 

We can only accept valid government issued identification (e.g. current driver's license, military ID, etc.).  "SELFIES" ARE NOT VALID FORMS OF IDENTIFICATION AND WILL NOT BE ACCEPTED.
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Reason for Request:


Select Delivery Method:


Please select the document delivery method



The individual listed on the Birth Certificate is:


Select The Information Type(s) Requested:


Total Fee:

$0

AUTHORIZATION NOTIFICATION:
My initials below constitute an electronic signature and authorizes the City of Houston Health Department to release information and / or my vital record and confirms I have completed all sections accurately and truthfully, including information verifying my identity. I understand that the recipient of the record(s) will use the indicated documents(s) for legitimate interests only and that the information contained therein shall not be further transferred or communicated to any other party or agency without my expressed written consent. I understand the penalty for knowingly making false statements on this form is a third degree felony and may be punishable with up to 2 - 10 years in prison and a fine of up to $10,000 Health and Saftey Code of Texas, Chapter 195, Sec. 195.003.
 

In the event that your birth certificate cannot be located, state law requires a $23 search fee. Search fees are non-refundable or transferable. The shipping fees will be refunded.

 
I have enclosed the correct fees and understand that they are nonrefundable. I understand that an incomplete form will not be processed and will be considered closed after expiration of the 30 day notification window. I declare under penalty of perjury that the foregoing is true and correct.
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