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It explains eligibility requirements for authorized persons under California Health and Safety Code and Family Code provisions, and the consequences of providing insufficient record information. The form collects registrant and applicant details, requires a sworn statement for certified copies, and notes notarization rules for mail requests. Submission instructions cover timelines, acceptable payment methods, required identification, and where to mail or deliver the completed application, including city vital records office details and office-use fields.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/pasadena-birth-certificate-application-2017/308457/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/pasadena-birth-certificate-application-2017/308457.png","ImageObject",442,249,{"name":88,"@type":89},"Theodore","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-23","2026-09-20",true,{"@type":98,"interactionType":99,"userInteractionCount":79},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"How long should you wait before submitting a Pasadena birth certificate request?","Question",{"text":108,"@type":109},"Wait three weeks from the date of the event before submitting your request.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"What is the difference between a certified copy and an informational copy?",{"text":113,"@type":109},"Certified copies require that you are an authorized person and include a sworn statement. Informational copies are marked “Informational, Not a Valid Document to Establish Identity,” and do not require a sworn statement or selecting an authorization category.",{"name":115,"@type":106,"acceptedAnswer":116},"What identification and signatures are required for requests?",{"text":117,"@type":109},"In-person requests require a valid photo ID. For mail requests requesting a certified copy, the sworn statement must be signed and notarized; the notary verifies the requester’s identity, not the relationship.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},308457,1790529051,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":79,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":73,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":139,"read_time":9},7971461740886,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","(PLEASE PRINT CLEARLY)  \nBirth certificates may be purchased as long as the birth occurred in the incorporated areas of the City of Pasadena. If we cannot identify the record based on the information provided, fees will be retained and a “Letter of No Record” will be issued. Fees are non-refundable, even if the record is not found. You will be asked to present a valid photo ID for all in-person requests.  \n⃝ Certified Copy ⃝ Informational Copy  \nYou may establish identity with this type of copy You may NOT establish identity with this type copy  \n1. BIRTH CERTIFICATE INFORMATION (REGISTRANT) No. of copies  Please wait 3 weeks from the date of the event before submitting your request.  \n\n| First Name | Middle Name | Last Name (Name Given at Birth) |  |\n| --- | --- | --- | --- |\n| Name of Hospital in Pasadena | Was there an adoption, amendment or name change?⃝Yes ⃝No | Sex\u003Cbr>⃝Female\u003Cbr>⃝Male | Date of Birth |\n| Mother/Father/Parent First Name | Middle Name | Last Name (Before Marriage/Domestic Partnership) |  |\n| Mother/Father/Parent First Name | Middle Name | Last Name (Before Marriage/Domestic Partnership) |  |\n\n2. APPLICANT INFORMATION (REQUESTOR)  \n\n| First Name | Middle Name | Last Name |\n| --- | --- | --- |\n| Mailing Address (Number, Street) | Apt \\#/Unit | Telephone Number\u003Cbr>( ) |\n| City | State | ZIP Code |\n\nPer California State Law, Health and Safety Code, Section 103526 (c), permits only authorized persons as defined below to receive certified copies of Birth Records. Those who are not authorized by law to receive a certified copy will receive a certified informational copy marked “Informational, Not a Valid Document to Establish Identity.” Request for an informational copy do not require a sworn statement and do not require an item to be selected from the list below.  \nTo receive a Certified Copy, I am:  \n⃝ The registrant (person listed on the certificate) or a parent or legal guardian of the registrant. (Legal guardian must provide documentation.)  \n⃝ A party entitled to receive the record as a result of a court order or an attorney or a licensed adoption agency seeking the birth record in order to comply with the requirements of Section 3140 or 7603 of the Family Code. (Please include a copy of the court order.)  \n⃝ A member of a law enforcement agency or a representative of another government agency, as provided by law, who is conducting official business. (Companies representing a government agency must provide authorization from the government agency.)  \n⃝ A child, grandparent, grandchild, brother or sister, spouse, or domestic partner of the registrant.  \n⃝ An attorney representing the registrant or the registrant’s estate, or any person or agency empowered by statute or appointed by a court to act on behalf of the registrant or the registrant’s estate.  \n⃝ Appointed rights in a power of attorney, or an executor of the registrant’s estate. (Please include a copy of the power of attorney, or supporting documentation identifying you as executor.)  \nPage 1 of 2 Revised 6/2017  \n3. SWORN STATEMENT * (Must be signed in the presence of the Pasadena Vital Records Staff or a Notary Public.)  \nI,   , declare under penalty of perjury under the laws of the State of California,(Applicant’s Printed Name)  \nthat I am an authorized person, as defined in California Health and Safety Code Section 103526 (c), and am eligible to receive a certified copy of the birth certificate identified on this application form.  \nSubscribed to this  day of   , 20   , at   ,    \n(Day) (Month) (City) (State)  \n(Applicant’s Signature)  \n* If you are requesting a certified copy by mail, you must have the above statement and the certificate of acknowledgement notarized. Please note: The notary is not certifying the relationship, only that you are the person requesting the copy. Requests for an informational copy do not require your signature to be notarized.  \nSUBMITTING APPLICATION  \nBy Mail:  \n􀁸 Payment may be made by check or money order made p","cbCaifqn8JJgAzYR","https://ap.wps.com/l/cbCaifqn8JJgAzYR","pdf",319325,"English","# Birth certificate purchase eligibility\n## Copy types and record lookup\n# Registrant and applicant information\n# Authorized recipients for certified copies\n## Sworn statement requirements\n# Submitting the application\n## By mail\n## In person\n## Office use only","[{\"question\":\"How long should you wait before submitting a Pasadena birth certificate request?\",\"answer\":\"Wait three weeks from the date of the event before submitting your request.\"},{\"question\":\"What is the difference between a certified copy and an informational copy?\",\"answer\":\"Certified copies require that you are an authorized person and include a sworn statement. Informational copies are marked “Informational, Not a Valid Document to Establish Identity,” and do not require a sworn statement or selecting an authorization category.\"},{\"question\":\"What identification and signatures are required for requests?\",\"answer\":\"In-person requests require a valid photo ID. For mail requests requesting a certified copy, the sworn statement must be signed and notarized; the notary verifies the requester’s identity, not the relationship.\"}]","Pasadena Birth Certificate Application - 2017 | PDF",1789869116]