Application to Prepare a Certificate of Foreign Birth form pdf Alabama

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APPLICATION TO PREPARE A CERTIFICATE OF FOREIGN BIRTH The Center for Health Statistics may prepare and register a Certificate of Foreign Birth upon receipt of a request from an adopti ve parent or an adopted individual 19 years of age or older. A Certificate of Foreign Birth may be put on file for a child who has automatically acquired United States citizenship following a foreign adoption and who possess es a Certificate of Citizenship in accor dance with the Child Citizenship Act . Upon receipt of the required and consistent documentation with the appropriate fee, the Center for Health Statistics will prepare a Certificate of Foreign Birth showing the child’s new name and the name(s) of the new parent (s). All of the following documents must be provided and must show consistent information in o rder to prepare the Certificate of Foreign Birth:  The child’s Certificate of Citizenship  A certified copy of the child’s foreign birth certificate and certified English translation  The certified original documents related to the child’s foreign adoption and certified English translation  The child’s Social Security card  A valid government issued picture identification of parent or parents, such as a passport, driver’s license, or military identification  Proof of current residency of the parent or parents in the State of Alabama. Submit at least one of the following: o Valid Alabama driver’s license o Current Alabama property tax bill o Current Alabama utility bill o Another record that conf irms Alabama residency The fee to prepare the Certificate of Foreign Birth is $25 .00 which includes one certified copy of the new record. Additional copies of the same record ordered at the same time are $ 6.00 each. There is an additional fee of $15.00 to expedite a request. Make check or money order payable to “State Board of Health .” Do not send cash. F ees a re n on -refundable . Complete the application below and send with the required documents and appropriate fee to : Center for Health Statistics Attention: Adoptions P.O. Box 5625 Montgomery, AL 36103-5625 If you have additional questions, call 334. 206. 2637 . Visit our website at www.alabamapublichealth.gov/vitalrecords . NOTE: If the child was born in another country to a U.S. citizen, contact the U.S. Department of State at 202.955.0307 or visit the website www.travel.state.gov . You must answer the following question: Is there a C ertificate of Foreign Birth on file or action pending for this child in another state? YES NO FULL NAME OF CHILD ON NEW BIRTH CERTIFICATE First Middle Last DATE OF BIRTH OF CHILD CITY AND COUNTRY OF BIRTH SEX FULL NAME OF ADOPTIVE M OTHER /PARENT First Middle Last BEFORE FIRST MARRIAGE DATE OF BIRTH OF ADOPTIVE MOTHER /PARENT STATE OF BIRTH OF ADOPTIVE MOTHER /PARENT (I f not in U.S.A., name country) FULL NAME OF ADOPTIVE FATHER / PARENT First Middle Last BEFORE FIRST MARRIAGE DATE OF BIRTH OF ADOPTIVE FATHER /PARENT STATE OF BIRTH OF ADOPTIVE FATHER /PARENT (I f not in U.S.A ., name country) APPLICANT SECTION (THIS SECTION MUST BE COMPLETED) Numbe r of Copies: __________ Amount Enclosed $ ___________ Valid identification is required to obtain a Certificate of Foreign Birth . Anyone providing false information or falsely applying for a record is subject to a penalty upon conviction of up to three months in the county jail or a fine of up to $500. Code of Ala. 1975, § 13A -10-109. By signing, you are certifying you have a legal right to the record r eques ted and all of the information provided on this form is true and correct. Your S ignature ________________________________________________________________ Date__________________________ Print Your Name _____________________________________________________________________________________________ Your R elationship to Child _ ____________________________________________________________________________________ Mail to Name ( if Different from You) ______________________________________________________________________________ Mail ing Address ______________________________________________________________________________________________ Cit y ____________________________________ State ____________ Zip ___________ Daytime Phone (_______)______________ I all ow the following individual to receive the certificate(s) _____________________________________________________________ ADPH -HS 8 4F B/REV. 06/2023