00 for each copy of the amended certificate requested. APPLICATION TO AMEND CERTIFICATE OF BIRTH STATE OF TEXAS NO. VITAL STATISTICS UNIT DEPARTMENT OF STATE HEALTH SERVICES P O BOX 12040 AUSTIN TEXAS 78711-2040 1-888-963-7111 This application supporting document s and the statutory filing fee of 15. 00 should be submitted to This fee does not include the cost of a certified copy of the record after the amendment is filed* Please enclose the additional fee of 22. Name Last First Middle Street Address Telephone 8am-5pm The penalty for knowingly making a false statement in this form can be 2-10 years in prison and a fine of up to 10 000. City State Zip Code Signature PART I. ENTER INFORMATION AS IT APPEARS ON THE ORIGINAL BIRTH CERTIFICATE* IF THE CHILD S NAME DOES NOT APPEAR ON BIRTH CERTIFICATE ENTER NOT SHOWN IN THE FIRST ITEM. Type or Print 1. FULL NAME OF CHILD 2. DATE OF BIRTH 3. PLACE OF BIRTH 4. SEX 5. STATE FILE NO. If known 6. FULL NAME OF FATHER 7. FULL MAIDEN NAME OF MOTHER P....
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How to fill out the TX VS-170 online
Filling out the TX VS-170 form is a necessary step for correcting a birth certificate in Texas. This guide provides clear, detailed instructions to help users navigate the process smoothly and efficiently.
Follow the steps to successfully complete the TX VS-170 form.
- Click the ‘Get Form’ button to access the TX VS-170 application and open it in the editor.
- Begin by filling out Section 1 with the applicant's information. This includes the full name, mailing address, email address, daytime telephone number, and relationship to the person named on the birth certificate.
- Move on to Section 2 where you will enter the birth certificate information as it appears currently. Include the birth certificate number, child’s name, date, and place of birth, as well as the full maiden names of both parents.
- In Section 3, specify what corrections you are requesting. List what is currently on the birth certificate and what it should say instead. If applicable, complete the court-ordered name change information.
- If you need to add, remove, or replace a parent's name, fill out Section 4. Provide the child's name for the new record and the necessary information for each parent.
- Determine whether you would like to request a certified copy of the corrected birth certificate in Section 5. Indicate your choice and enter the desired quantity.
- Complete Section 6 by signing in the presence of a notary public and attach a copy of your valid photo ID. Make sure all notary requirements are met.
- Once all sections are filled out correctly, ensure that required documentation is attached. After verifying everything, you are ready to save changes, download, print, or share the completed form.
Complete your TX VS-170 application online today to ensure your birth certificate is amended accurately.
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