DH 527, 09/2017, Florida Administrative Code Rule 64V-1.0031 (Obsoletes Previous Editions)
TYPE OR PRINT IN BLACK INK
(Prompt submission of this statement, when properly completed, will ensure the timely filing of a new birth certificate.)
Pursuant to §. 63.152, Florida Statutes, within 30 days after entry of a judgment of adoption, the clerk of the court, and in agency
adoptions, any child-placing agency licensed by the department, shall prepare a certified statement of the entry for the State Registrar
of Vital Statistics on a form provided by the registrar. A new birth record containing the necessary information supplied by the certificate
shall be issued by the registrar on application of the adoptive parent(s) or the adopted person.
Provide all information. This will ensure timely filing of a new birth certificate. Providing contact information is critical in case contact
with the person completing the form and/or the attorney is needed to obtain additional or clarifying information.
Section B. Complete all information regarding both mother/parent and father/parent regardless of whether a stepparent adoption or two
new parents. This information is required for completion of a new birth certificate. In the case of a stepparent adoption, the information
allows us to verify information already on file.
Fee: Florida law requires a $20.00 fee made payable to “The Office of Vital Statistics” for filing a new birth certificate for a Florida
birth resulting from adoption. This fee includes the issuance of one certification of the new certificate. Certification of the new certificate
cannot be provided prior to the payment of this fee. If the fee is accompanying this statement, please DO NOT send cash. Please send
a check or money order made payable to the Office of Vital Statistics. DH Form 429, Application for Amendment to Florida Birth
Record, should be used when remitting the fee. This will ensure that the new certificate is mailed to the appropriate party as listed on
If the fee is not remitted at the time of the submission of this statement, the birth record, if the birth occurred in Florida, shall be amended
and the record flagged for collection of the Amendment/Processing fee at the time certification of the new record is requested.
Upon receipt of the report of adoption from a clerk of the court, as heretofore provided for, or upon receipt of a certified copy of a final
decree of adoption, together with all necessary information, the State Registrar shall make and file a new birth certificate. All names
and particulars entered in the new certificate shall refer to the adoptive parents. The original birth record and court documents shall be
sealed only to be opened pursuant to a court order or other provision as may be provided for in Florida law.
Form is also used for adoption of foreign child pursuant to §. 382.017, F.S. which allow the creation of a Certificate of Foreign Birth.
Forms may be obtained through our website below.
OUT OF STATE BIRTHS – ADOPTIONS GRANTED IN FLORIDA: Although birth certificates for these children are not placed
on file in our state, the adoption report sent to our office from the court shall be forwarded to the appropriate registration authority in
the state of birth. DO NOT remit the fee when the birth occurred outside of the State of Florida.
If you have any questions regarding the completion of this form, you may contact the Office of Vital Statistics at (904) 359-6900, ext.
MAIL THIS FORM WITH PAYMENT AND APPLICATION (DH 429) TO:
DEPARTMENT OF HEALTH
OFFICE OF VITAL STATISTICS
ATTN: ADOPTION UNIT
P.O. BOX 210,
Jacksonville, FL 32231-0042
(Street Address: 1217 North Pearl Street, Jacksonville, Florida, 32202)
PLEASE VISIT OUR WEBSITE: