City of Houston Health Department Online Birth Certificate Requests

This is an official, online vital record request.

Please note the following:

The fee will be paid through Permitium Payments. The charge will show on your credit card statement as 'PermVitalRecs'

Attention:

The State of Texas requires that all applicants provide valid identification before their application can be processed. Click on the button below for information on the forms of identification acceptable.

Failure to provide valid identification, will result in denial of the order. A convenience fee of five dollars (for the online service) will be withheld from the reimbursement.
Failure to provide any addtional requested supporting documentation, will result in denial of the order. A convenience fee of five dollars (for the online service) will be withheld from the reimbursement.
For Death records: If the name of the city or the precinct is not listed among the "Place of Death" menu, the record is not filed with this office. Please terminate your request!

Click here for list of forms of identification

Click here for information regarding qualified applicants

Please Enter The Full Name Of Deceased:

Last Name: ^{(full name, no initials)}

First Name:

Middle Name:

Maiden Name:

Suffix:

Parent Names of the Deceased:

Mother's Last Name:

Mother's First Name:

Father's Last Name:

Father's First Name:

Please Enter The Location Of Death:

Date of Death:

Confirm Death Year:

Death Location City:

Place of Death:

Death County:

Death State:

Funeral Home

Funeral Home:

Please Enter The Requestor's Name:

Last Name: ^{(full name, no initials)}

First Name:

Middle Name:

Maiden Name:

Suffix:

Requestor Date of Birth:

Requestor Current Age:

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

Address Line 1:

Address Line 2:

City:

State: ^(region)

Zip Code: ^{(postal code)}

Country:

^{Mailing Address Different:}

Yes No

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

Address Line 1:

Address Line 2:

City:

State: ^(region)

Zip Code: ^{(postal code)}

Country:

Requestor's Contact Telephone Numbers: ^{(###-###-####)}

^Home:

^Work:

^Cell:

^Fax:

Updates via Text Message?

Yes No

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

^{ID Number:}

^{Issuing State:}

Requestor's Email:

^Address:

^Confirm:

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. Please note: Failure to upload valid ID at this time will result in delays while processing your request.

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Special Instructions :

Reason for Request:

Select Reason:

Select Delivery Method:

Please select the document delivery method

SAME-DAY PICK-UP

Houston Health Department
8000 North Stadium Drive
Houston, TX 77054

NOTE: Same-Day Pick-Up if ordered by 2:00 pm (CST), otherwise available after 10:00 am (CST) next business day. Orders are typically ready 2 hours after a complete application is submitted. Note: Orders not picked up in 30 days will be destroyed and the search fees will NOT be refunded.

I would like my document(s) delivered via MAIL to my CURRENT address.

The individual listed on the Death 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 certificate cannot be located, state law requires a search fee equal to the certificate cost be collected. Search and convenience fees are non-refundable or transferable. The shipping fees may 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.

Coupon Code:

Requestor's Initials:

Clear Form

Online Death Certificate Request
Step 1, Please Enter All Information

Attention:

Click here for list of forms of identification

Click here for information regarding qualified applicants

Please Enter The Full Name Of Deceased:

Parent Names of the Deceased:

Please Enter The Location Of Death:

Other Place of Death:

Funeral Home

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 attach your photo identification

Reason for Request:

Select Delivery Method:

Documents Will Be Delivered To: ^{please enter the delivery addresses}

The individual listed on the Death Certificate is:

Other Relationship:

Select The Information Type(s) Requested:

Total Fee:

$0

Online Death Certificate RequestStep 1, Please Enter All Information

Attention:

Click here for list of forms of identification

Click here for information regarding qualified applicants

Add An Address

Notice:

A Shipping Address Is Required!

Please Enter The Full Name Of Deceased:

Parent Names of the Deceased:

Please Enter The Location Of Death:

Other Place of Death:

Funeral Home

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 attach your photo identification

Reason for Request:

Select Delivery Method:

Documents Will Be Delivered To: please enter the delivery addresses

The individual listed on the Death Certificate is:

Other Relationship:

Select The Information Type(s) Requested:

Total Fee:

$0

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Online Death Certificate Request
Step 1, Please Enter All Information

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)}

Documents Will Be Delivered To: ^{please enter the delivery addresses}