JAMES D. PATTON

County Clerk

P. O. Box 210

Huntsville, TX 77342

Ninfa Fuentes, Chief Deputy

APPLICATION FOR BIRTH & DEATH RECORDS

      Fees:  Birth Certificates $22.00 each / Death Certificates $20.00 for the first copy and $3.00 for each additional issued at the same time.

                Please check Payment Method: check(  ) money order (  ) cashiers check (  ) 

      To order a birth or death certificate by mail please complete and mail this form along with payment. Please include a copy of your  Driver's License or I.D. or it will not be processed!

1. Name on record                                                                                                                                 

                                                           First                          Middle                         Last

2. Date of birth or death                                                                                                                        

3. Place of birth or death                                                                                                                        

    *We only have records for Walker County please see the link below for other counties.

4. Father name                                                                                                                                       

5. Mothers maiden name                                                                                                                      

6. Relationship to person who's certificate is required                                                                      

    (Must be an immediate family member: husband, wife, child, parent, grandparent, or grandchild)

7. State the reason for obtaining the certificate                                                                                     

8. Mailing address                                                                                                                                    

9. Signature of Applicant                                                           D.L. or I.D. No.                                    

Birth records are confidential for 75 years and death records are confidential for 25 years.

** Warning: The penalty for knowingly making a false statement when applying for a birth or death record can be 2-10 years in prison and up to $10, 000. (Health and Safety Code, Chapter 678, Sec. 195.003)

 

If the birth or death did not occur in Walker County please contact Texas Department of State Health Services Bureau of Vital Statistics at www.tdh.state.tx.us