Office of John F. Warren County Clerk Records Building 509 Main St Ste 200 Dallas, Texas 75202 (214) 653 - 7477 Dallas County, Texas Certified copy of Birth or Death Certificate Information Qualified Applicants Birth records are confidential for 75 years. Death records are confidential for 25 years. Qualified Applicants that may submit a request for a Birth/Death Certificate (must have valid state issued ID or Driver’s License): • • • • Self Spouse Grandparent Parent • • • Child Sibling Legal Representative (Must have a certified copy) The Dallas County Clerk office only provides the long form birth certificate and death certificates that occurred in Dallas County excluding the City of Dallas. Long Form Birth Certificates and Death Certificates AVAILIBLE for the following Cities Addison Balch Springs Carrollton Cedar Hill Cockrell Hill Coppell Desoto Duncanville Farmers Branch Garland Glenn Heights Grand Prairie Highland Park Hutchins Irving Lancaster Las Colinas Mesquite Richardson Rowlett Please visit www.DallasCounty.org for more information Sachse Seagoville Sunnyvale University Park Wilmer/Wylie Long Forms NOT AVAILIBLE for the following hospitals Baylor University Medical Center * 3500 Gaston Ave Charlton Methodist Hospital * 3500 W. Wheatland Rd Children's Medical Center of Dallas * 1935 Motor St Dallas Veterans Affairs Medical Center 4500 S. Lancaster Doctors Hospital * 9330 Poppy Drive Green Oaks Psychiatric Hospital * 7808 Clouds Fields LifeCare Hospital of Dallas * 6161 Harry Hines Mary Shiels Hospital * 3515 Howell St. Medical City Children's Hospital * 7777 Forest Lane Medical City Dallas * 7777 Forest Lane Methodist Medical Center * 1441 N. Beckley Avenue Parkland Memorial Hospital * 5201 Harry Hines Presbyterian Hospital of Dallas * 8200 Walnut Hill Renaissance Hospital Dallas * 2929 S. Hampton Rd St. Paul Medical Center * 5909 Harry Hines Texas Scottish Rite Hospital for Children * 2222 Welborn Visit www.Texas.Gov or www.DallasCityHall.com for more information Processing Times Routine processing may take up to 2 weeks. Expedite your service by mailing your request by Express Mail. You may also provide an enclosed paid envelope. Expedited processing may take up to 2-3 business days. Mail the following Items 1. Form 2. Copy of ID 3. Money Order Payable to: Dallas County Clerk (Printed no more than 60 days) 4. Optional: Self Addressed Pre-postage Envelope Mailing Address Dallas County Clerk’s Office ATTN: Birth/Death Certificate 509 Main St Suite #200 Dallas, TX 75202 Office of John F. Warren County Clerk Request for certified copy of Dallas County Birth or Death Certificate Dallas County, Texas Type of Request Please select the document(s) for which you are applying Birth Type # of Copies Death Cost Total Type # of Copies Abstract $23 each $ 0 Original* Long Form* $23 Each $ 0 Additional Copies $ 0 Total Cost *View list on front for availability Cost Total $21 (1st copy) $ 0 $4 each $ 0 $ 0 Total Cost *View list on front for availability RECORD INFORMATION (Information de certificado ) Name on Record: (Nombre) First name/Primer nombre Date of Birth: (Nacimiento) Middle/Segundo Last Name/Appellido Date of Death Month/Mes Place of Birth/Death: (Lugar) Day/Dia Year/Año City or Town/ Cuidad de naciamento Hospital Name: (Hospital) (Desfuncion dia) Month/Mes Day/Dia County/Condado de naciamento Year/Año State/Estado de naciamento We do not offer Birth/Death Certificates for the City of Dallas No ofrecemos actas de nacimiento/desfuncion para la cuidad de Dallas Hospital Name/Nombre de hospital Fathers Name: (Padre) First/Primer Anterior Middle/Segundo Anterior Last Name/Apellido Mothers Name: (Madre) First/Primer Anterior Middle/Segundo Anterior Last Name/Apellido Anterior REQUESTOR’S INFORMATION (Information de solicitante) Relationship to above: Name: (Nombre) First/Primer Home address: (Domicilio) Phone #: (Telefono) (Self, Mother of , Father of, Sister of, Brother of, Daughter of, Son of, Grandparent of, etc) Middle/Segundo # Street/Calle ( Mailing address (if different) (Lugar de correo) ) Apt # State/Estado First/Primer # Street/Calle Middle/Segundo Apt # Date: City/Ciudad Check √ (Must sign to process) WARNING: IT IS A FELONY TO FALSIFY INFORMATION ON THIS DOCUMENT. THE PENALTY FOR KNOWINGLY MAKING A FALSE STATEMENT ON THIS FORM OR FOR SIGNING A FORM WHICH CONTAINS A FALSE STATEMENT IS 2 TO 10 YEARS IMPRISONMENT AND A FINE UP TO $10,000. (HEALTH AND SAFETY CODE, CHAPTER 195, SEC 195.003) Last/Apellido State/Estado Zip Code/Codigo Identifying Documents (include copy) Driver’s License Date Issued Passport Expiration Date Place of Issue Other Zip Code/Codigo @ (For Receipt) Name of person receiving mail (if different): (Persona recibiendo documento) Requestor’s Signature City/Ciudad E-mail: - X Last Name/Appellido Office use only Issuing Clerk Amount Received Receipt # Location Security # Year Volume Page Form revised 09/27/2013 DCCYWOT