Certified copy of Birth or Death Certificate Information

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
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