Parent permission

Note: This must be signed in front of a Notary in addition to any other form.

To The Department of State-Passport Vital Records

Section I.  I, (name of birth certificate holder):

__________________________________________ give permission for my parent

(Name of parent requesting):


to request and receive my birth certificate for me since I have no current valid ID to do it
for myself.

Certificate holder signature: _____________________________________________________

Date: ______/________/20________


Notary signature: _____________________________    Date: _____________

My commission expires on: ____/_____/ 20___