1. HOSPITAL RECORD AT BIRTH
2.
BAPTISMAL CERTIFICATE
Must be within fir
st 5 years
of life.
3.
ELEMENTARY SCHOOL RECORD
Must be signed by custodian of
school records based on earliest
attendance.
4. BIRTH CERTIFICATE OF
REGISTRANT’S OLDER
BROTHER OR SISTER
5.
ARMED FORCES DISCHARGE
PAPERS
6. NUMIDENT PRINTOUT from the
Social Security Administration
(SSA) issued by the SSA, Office of
Privacy and Disclosure, 617
Altmeyer Bldg., 6401 Security Blvd,
Baltimore, MD 21235
7.
THE PETITION FOR NATURALIZATION
that includes the name change. Call the
Immigration and Naturalization Service
(ICE) at 800-375-5283 to obtain
information on how to secure this
document.
8.
FEDERAL CENSUS
9.
MARRIAGE RECORD OF PARENTS
A copy of certificate, license, or
application,
whichever
supplies
the
required
facts.
(limited
use)
10.
BIRTH CERTIFICATE(S) OF
REGISTRANT’S PARENT(S)
11.
DIVORCE DECREE (limited use)12.
JUDICIAL ACTIONS
A certified copy of any court action
affecting any information shown on
the birth certificate.
VS-170
ACCEPTABLE DOCUMENT ARE SUFFICIENT. TYPES OF DOCUMENTS
A. ADDING INFORMATION
[Items left blank on original certificate]
[1] children 17 and under .............................................................. Affidavit signed by both parents
[2] adults, 18 and over ................................................................... Affidavit by older relative
B. CORRECTIONS IN SPELLING
[Names having the same sound].................................................. Affidavit by parent(s) or older relative
C. FIRST OR MIDDLE NAME ........................................................... Affidavit and one document (see 1 & 2 under A)
D. SIGNIFICANT CHANGE IN LAST NAME ..................................... A certified court order
E. SEX .............................................................................................. Affidavit by medical attendant or affidavit and one document.
Court Order required if change is a result of gender reassignment
surgery.
NAME OF FATHER
[Refer to examples listed under name unless item is left blank]
[1] To add information when item is left blank ........................... A paternity determination (this form cannot be used to add father’s
name; contact Vital Statistics)
PART VI. SUGGESTED TYPES OF DOCUMENTARY EVIDENCE. THE CERTIFIED DOCUMENT MUST SHOW THE CORRECT
INFORMATION AND HAVE ORIGINAL CERTIFICATION REGARDING THE ITEM(S) TO BE CORRECTED.
PART V. EXAMPLES OF CORRECTIONS AND TYPES OF DOCUMENTS REQUIRED. GENERALLY, THE AFFIDAVIT AND ONE
NOTE: IF THERE IS NOT AN OLDER RELATIVE, THE PERSON ON THE BIRTH RECORD CAN SIGN, IF ACCOMPANIED BY AN
ACCEPTABLE DOCUMENT.
NOTE: ALL OTHER ITEMS REQUIRING CORRECTION SHOULD BE REFERRED TO VITAL STATISTICS FOR
INSTRUCTIONS ON DOCUMENTATION.
NOTE: FOREIGN DOCUMENTS, INCLUDING NOTARIES - MUST HAVE APOSTILLE OR LEGALIZATION
NOTE: IF THIS IS A HOSPITAL CORRECTION, THEN ONLY THE HIM DIRECTOR CAN SIGN THE AFFIDAVIT.
SCHOOL CENSUS
13.
EXPEDITED SERVICES:
Orders must be sent to the Texas Department of State Health Services via an overnight mail service
such as: Fedex, Lone Star Overnight, or UPS.
ADDITIONAL $5 CHARGE FOR EXPEDITED REQUESTS.
$8 RETURN DELIVERY FOR LONESTAR (within Texas) OR FEDEX (outside of Texas)
$19.95 FOR P.O. BOX AND EXPRESS MAIL (optional)
MAILING ADDRESS FOR EXPEDITED SERVICE:
VITAL STATISTICS UNIT
1100 W. 49TH STREET
AUSTIN, TX 78756
NOTE: ALL SUPPORTING DOCUMENTS MUST MATCH THE REQUESTED CORRECTION(S) EXACTLY.
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