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76a639b rev 6 19 fillable 2026

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  1. Click ‘Get Form’ to open the 76a639b rev 6 19 fillable in the editor.
  2. Begin by selecting the type of certificate you are requesting: either an AUTHORIZED copy or an INFORMATIONAL copy. Check the appropriate box.
  3. Fill in the number of copies you need in the designated field.
  4. Enter the registrant's date of birth, including month, day, and year. Ensure this information is accurate.
  5. Provide the NAME GIVEN AT BIRTH, including first, middle, and last names.
  6. Indicate the CITY OF BIRTH clearly.
  7. Complete the birth names of both parents as required in their respective fields.
  8. Certify your declaration by signing and dating at the bottom of the form. Include your phone number for contact purposes.
  9. Finally, print your name and mailing address legibly to ensure proper delivery.

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APPLICATION FOR BIRTH RECORD

76A639B Rev. 5/10. FOR RECORDER USE ONLY. File Number. Searched. Doubled. Page 2. SPECIAL NOTICE TO VETERANS. You may be eligible for a free certified copy ifRead more

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