AZ Certificate of Live Birth Worksheet free printable template

ARIZONA DEPARTMENT OF HEALTH SERVICES OFFICE OF VITAL RECORDS CERTIFICATE OF LIVE BIRTH WORKSHEET 1A. TOTAL PRENATAL VISITS If none enter 0 Date of first prenatal visit Was the prenatal record used for completion of birth certificate Date of last prenatal visit 48. CHILD S FIRST NAME Child Not Named 2. SEX Male Female Not yet determined 1B. MIDDLE NAME 3. DATE OF BIRTH / / Mo Day Year 1C. LAST NAME 4. TIME OF BIRTH AM-PM Military 1D. SUFFIX 5. COUNTY OF BIRTH e*g* Maricopa Pima etc*...

How to fill out certificate of live birth vs birth certificate form

How to fill out AZ Certificate of Live Birth Worksheet

1. Obtain the AZ Certificate of Live Birth Worksheet from the appropriate state department website or office.
2. Fill in the child's full name as it appears on the birth certificate.
3. Provide the date of birth of the child.
4. Include the child's place of birth (city and hospital, if applicable).
5. Enter the parents' names, including the mother's maiden name.
6. Fill out the parents' birthplaces (city and state for both parents).
7. Provide the time of birth (if known) and the sex of the child.
8. Sign and date the worksheet at the bottom.

Who needs AZ Certificate of Live Birth Worksheet?

1. Parents or guardians of a newborn child.
2. Healthcare providers who need to report a birth.
3. Individuals applying for a birth certificate for the child.
4. Legal representatives involved in matters requiring proof of birth.

People Also Ask about blank certificate of live birth form

How much does it cost to get a new birth certificate in AZ?

Arizona Birth Certificate fees The fee for Arizona amounts to $20 and is payable to the Office of Vital Records. Each additional copy will carry a further $20 fee. You can pay by money order, cashier check, or credit card (Visa and Mastercard are supported).

How do I get a copy of my birth certificate in Arizona?

You may apply for a certified copy of a birth or death certificate by mail. If you would like same day walk in customer service please visit your local county health department Office of Vital Records.

What do you need to get a copy of your birth certificate in Arizona?

By Mail: Print and complete an application for the certified copies of the certificate you wish to order. Sign your application. Attach a clear photocopy of your valid, government issued photo ID with signature or have your signature notarized on the application form.

How do I get my birth certificate the same day in Arizona?

You may apply for a certified copy of a birth or death certificate by mail. If you would like same day walk in customer service please visit your local county health department Office of Vital Records.

How do I get a copy of my birth certificate in Phoenix?

Birth Certificates We are OPEN for walk-in service for issuance. Please call 602-506-6805 to schedule an appointment, listen carefully to the message, and select the option that best suits your service need. We thank you for your patience, and know we look forward to providing you outstanding service!

How can I get my birth certificate fast in Arizona?

Note: **Allow 1-2 weeks for processing to receive your certified copy in the mail. Fastest service is in person - may be quicker than mail or expedited, online ordering.

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What is AZ Certificate of Live Birth Worksheet?

The AZ Certificate of Live Birth Worksheet is a document used in Arizona to record the details of a newborn's birth, including personal information about the child and parents, for official registration purposes.

Who is required to file AZ Certificate of Live Birth Worksheet?

The AZ Certificate of Live Birth Worksheet must be filed by the parents of the newborn or the attending physician or midwife responsible for the delivery.

How to fill out AZ Certificate of Live Birth Worksheet?

To fill out the AZ Certificate of Live Birth Worksheet, complete all required fields with accurate information, including the child's name, date of birth, parents' names, and other relevant details as instructed on the form.

What is the purpose of AZ Certificate of Live Birth Worksheet?

The purpose of the AZ Certificate of Live Birth Worksheet is to formally document the birth of a child, which is essential for obtaining a birth certificate and for legal identification.

What information must be reported on AZ Certificate of Live Birth Worksheet?

The AZ Certificate of Live Birth Worksheet requires reporting of information such as the child's name, date and place of birth, parents' names and addresses, and other demographic details related to the birth.