Designation to Obtain a Vital Record Form

This form's purpose is to give us permission to apply for the record you are requesting without you having to be present. This form needs to be filled out completely and correctly in order for us to obtain the record. Please follow the instructions below:

1. Please take your time filling out the form to ensure you fill every section out correctly.
2. When filling out the mother's name, you must put her MAIDEN middle and last name, not her current name.
3. Do NOT sign the form until you are in front of a notary.
4. Once you have completed the form, find a notary to notarize it.
5. Once the form is notarized, please mail the original (can't be a copy) via USPS to:

Texas Birth Certificate

P.O. Box 301737

Austin, TX 78703