USVI Public Records

Document text

THE VIRGIN ISLANDS OF THE UNITED STATES DEPARTMENT OF HEALTH OFFICE OF VITAL RECORDS AND STATISTICS APPLICATION FOR CERTIFIED COPY OF BIRTH RECORD Do Not Complete This Application Before Reading The Instructions And Information On The Back Of This Form PART A. TYPE OF CERTIFIED COPY REQUESTED: CHECK ONE: _______Birth Verification Fee $6.00 _______Birth Certificate Fee $15.00 A verification is an abstract from the birth A certificate is an abstract from the birth record record that gives the name and date of birth. that gives the name, date of birth, gender, place of birth and parents’ names. PART B. ELIGIBILITY: BIRTH VERIFICATION Anyone may apply for a death verification. BIRTH VERIFICATION CHECK ONE: ______ I am the person listed on the record and am at least 18 years. ______ I am a parent or legal guardian of the minor person listed on the record. ______ I am a party entitled to receive the record as a result of a court order. ______ I am an attorney representing the person listed on the record. PART C. DISTRICT APPLYING TO: CHECK ONE - St. Croix District St. Thomas/St. John District PART D. BIRTH RECORD INFORMATION: First Name on Record Middle Name on Record Last Name on Record Date of Birth – mm/dd/yy Place of Birth (City and Island) Gender (Check One) Male Female Mother’s / Parent’s Name Mother’s / Parent’s Place of Birth Mother’s / Parent’s Physical Address (At Time of Birth of Person Whose Record Is Requested) Mother’s / Parent’s Age at Birth (Of Person Whose Record Is Requested) Father’s / Parent’s Name Father’s / Parent’s Place of Birth Father’s / Parent’s Physical Address (At Time of Birth of Person Whose Record ss Requested) Father’s / Parent’s Age at Birth (Of Person Whose Record Is Requested) PART E. APPLICANT INFORMATION: Applicant’s First Name Applicant’s Middle Name Applicant’s Last Name Applicant’s Mailing Address State City Zip Code Type of Photo Id Photo Id# Relationship to Person on Record Purpose for Which Record is Requested Amount Enclosed Money Order ID # PART F. MAIL COPY OF RECORD TO: (ONLY COMPLETE THIS SECTION IF FORWARDING ADDRESS IS DIFFERENT FROM APPLICANT’S MAILING ADDRESS) First Name Middle Name Last Name Mailing Address Number of Copies State City Zip Code ( ) Signature of Applicant Physical Address Date Telephone # Do Not Complete Below Unless In The Presence Of A Notary Public Sworn To And Subscribed Before Me This __________ Day Of ___________________ _______. WITNESS My Hand And Official Seal. Day Month Yea (Notary Public’s Signature) INSTRUCTIONS Please submit the following: 1. Completed, notarized application TO THE DISTRICT WHERE THE BIRTH OCCURRED. Virgin Islands Department of Health Virgin Islands Department of Health St. Thomas/St. John District or St. Croix District Office of Vital Records and Statistics Office of Vital Records and Statistics 1303 Hospital Ground, Suite 10 4006 Estate Diamond, Suite 104 St. Thomas, VI 00802. St. Croix, VI 00820. 2. Photocopy of your valid picture identification document such as your driver’s license, passport card, military identification card, permanent resident card, TWIC card, valid voter’s card, state issue d identification card, or senior citizen’s card. 3. Certified copy of court/appointment document if applying as legal representative or legal guardian. 4. United States Postal Money Order in the amount of $15.00, made payable to the Virgin Islands Department of Health. (NO PERSONAL CHECKS WILL BE ACCEPTED) 5. Court Order amendments is an additional fee of $30.00. Please call the office for additional information. 6. A returned stamped envelope must be sent with the application and must have the returned address to return the Birth Certificate(s). SEE POSTAL CARRIER FOR RATES (U.S. PRIORITY OR EXPRESS MAIL, FEDEX, DHL, UPS) 7. Submittal of an incomplete application will delay processing. 8. If a record is not found, a certified “No Record Found” letter will be issued. 9. If an application is incomplete and applicant is unreachable by phone, a “Missing Information” letter will be issued. It is very important to provide all required information on the application. CONTACT INFORMATION Virgin Islands Department of Health Virgin Islands Department of Health Virgin Islands Department of Health Office of Vital Records and Statistics Office of Vital Records and Statistics Office of Vital Records and Statistics St. Thomas, VI St. Croix, VI St. John, VI Tel#: (340) 774-9000 Cell#: (340) 643-6302 Tel#: (340) 776-6400 Ext. 4685/4681/4683 Tel#: (340) 712-0117/(340) 712-0119 Ext. 6014 Tel#: (340) 715-5116 or (340) 712-0116 or (340) 712-0118 (340) 715-5117