Dallas County
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County home
Vital Certificates Application Form
Select Birth or Death Certificate Order Type
*
Birth Certificate
Death Certificate
Birth Certificate
Child's First Name
Child's Middle Name
Child's Last Name
Child's Gender
*
Male
Female
Date Of Birth
City of Birth
County of Birth
State of Birth
-- State --
AL
AK
AZ
AR
AE
AA
AP
CA
CN
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MX
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Parent 1 First Name
Parent 1 Middle Name
Parent 1 Last (or Maiden) Name
Parent 2 First Name
Parent 2 Middle Name
Parent 2 Last (or Maiden) Name
Purpose for obtaining copy of Birth Certificate (please check all that apply)
*
Drivers License/ID
Housing
Insurance
Passport
Records
Social Security
School
Travel
Veterans
Welfare
Other
Applicant's First Name
Applicant's Middle Name
Applicant's Last Name
Applicant's Phone Number
Relationship to Registrant
Applicant's Address
Zip Code
City
State
-- State --
AL
AK
AZ
AR
AE
AA
AP
CA
CN
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MX
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
ID Type and Number
ID Expiration Date
Death Certificate
Deceased First Name
Deceased Middle Name
Deceased Last Name
Deceased's Gender
*
Male
Female
Date Of Death
City of Death
County of Death
State of Death
-- State --
AL
AK
AZ
AR
AE
AA
AP
CA
CN
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MX
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Parent 1 First Name
Parent 1 Middle Name
Parent 1 Last (or Maiden) Name
Parent 2 First Name
Parent 2 Middle Name
Parent 2 Last (or Maiden) Name
Purpose for obtaining copy of Death Certificate (please check all that apply)
*
Drivers License/ID
Housing
Insurance
Passport
Records
Social Security
School
Travel
Veterans
Welfare
Other
Applicant's First Name
Applicant's Middle Name
Applicant's Last Name
Applicant's Phone Number
Relationship to Registrant
Applicant's Address
Zip Code
City
State
-- State --
AL
AK
AZ
AR
AE
AA
AP
CA
CN
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MX
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
ID Type and Number
ID Expiration Date