Arkansas Birth Certificate Application Form
This document is an application form for obtaining a birth certificate from the Arkansas Department of Health. It includes fields for personal information, parental details, and identification requirements. The form provides instructions for submission via mail, online, phone, or in-person.
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How do I fill this out?
To fill out this form, start by entering the full name, date of birth, and place of birth of the individual whose certificate is being requested. Include parental details and provide a valid government-issued ID. Ensure all required fields are completed and follow the submission instructions provided.
How to fill out the Arkansas Birth Certificate Application Form?
1
Enter the full name at birth, date of birth, and place of birth.
2
Provide parental details including full names of father and mother.
3
Indicate the relationship to the person whose certificate is being requested.
4
Provide a valid photo ID and attach a copy of it with the form.
5
Follow the submission instructions for mailing, online, phone, or in-person requests.
Who needs the Arkansas Birth Certificate Application Form?
1
Individuals seeking a birth certificate for personal records.
2
Parents needing a birth certificate for their child.
3
People applying for a passport or other identification requiring a birth certificate.
4
Individuals needing proof of birth for legal purposes.
5
Adopted individuals seeking their original birth certificate.
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What are the instructions for submitting this form?
To submit this form, you can mail it to the Arkansas Department of Health at 4815 W. Markham St., Slot 44, Little Rock, AR 72205. You can also submit it online via ar.gov/vitalrecords, by phone at (866) 209-9482, or in-person at the Vital Records Office at 4815 W. Markham St., Little Rock, AR. Ensure to include a valid photo ID and payment. For mail submissions, do not send cash; use checks or money orders.
What is the purpose of this form?
The purpose of the Arkansas Birth Certificate Application Form is to facilitate the issuance of official birth certificates by the Arkansas Department of Health. Birth certificates are essential official records for various personal, legal, and administrative purposes. This form ensures that all necessary information and identification are provided, streamlining the process for applicants.
Tell me about this form and its components and fields line-by-line.
- 1. Full Name at Birth: Enter the individual's first, middle, and last name as it appears on the birth record.
- 2. Date of Birth: Provide the individual's date of birth, including month, day, and year.
- 3. Place of Birth: Specify the city or town, name of hospital, or street address where the birth occurred.
- 4. Sex: Select the individual's sex.
- 5. Full Name of Father: Enter the full name of the individual's father.
- 6. Full Maiden Name of Mother: Enter the mother's full name before marriage.
- 7. Relationship to Person: Indicate your relationship to the individual whose certificate is being requested.
- 8. Reason for Request: Provide the reason for requesting the birth certificate.
- 9. Is Person Still Living: Indicate whether the individual is still living.
- 10. Signature and Contact Information: Include your signature, contact number, and email address.
What happens if I fail to submit this form?
Failure to submit this form can result in delays or inability to obtain a birth certificate.
- Incomplete Application: An incomplete application may lead to processing delays.
- Missing Identification: Failure to provide valid photo ID can result in rejection.
- Incorrect Information: Providing incorrect information can result in a failed request.
How do I know when to use this form?
- 1. Personal Records: To obtain an official copy for personal record-keeping.
- 2. Legal Purposes: For legal matters requiring proof of birth.
- 3. Identification Applications: When applying for a passport or other identification requiring a birth certificate.
- 4. Adoption Processes: For adopted individuals seeking their original birth certificate.
- 5. Genealogy Research: For ancestral research and family history documentation.
Frequently Asked Questions
How do I fill out the Arkansas Birth Certificate Application Form?
Enter the necessary personal and parental details, provide a valid photo ID, and follow the submission instructions provided in the form.
Can I edit the form online?
Yes, you can use PrintFriendly's PDF editor to fill out and modify the form online.
How can I sign the PDF form?
Use PrintFriendly to electronically sign the form by uploading your signature or drawing it directly within the document.
What identification is required for obtaining a birth certificate?
A government-issued photo ID such as a driver's license, passport, or other accepted forms listed in the form.
How can I submit the completed form?
The form can be submitted by mail, online, phone, or in-person as per the instructions provided.
What is the fee for obtaining a birth certificate?
The first copy costs $12 and each additional copy of the same record costs $10.
Is there an extra fee for online submissions?
Yes, there is a non-refundable $5.00 processing fee and a $1.85 identity verification fee for online submissions.
Can I request a birth certificate for an adopted individual?
Yes, you can request it by providing the original name if known.
What happens if my request cannot be fulfilled?
If the birth record is not found, the $12 search fee will be retained as a search charge.
Can I track the status of my request?
You should allow 7-14 days for processing. For status updates, contact the Arkansas Department of Health directly.
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