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Application for Certified Copy of Birth/Death Certificate

  1. Port Arthur Health Department
    ATTN: Vital Statistics, 449 Austin Avenue Port Arthur, Texas, 77640
  2. For Service By Mail:

    Submit Check or Money Order Payable to: CITY OF PORT ARTHUR to above address. Please send completed application, Notarized Proof of Identification & Affidavit of Personal Knowledge, and Photocopy of a Valid Identification 


    Certified Birth Certificate Copies are $23.00 per copy*

    Certified Death Certificate Copies are $21.00 per copy*

    *Additional copies $4.00 per copy

  4. 1. Full Name of Person on the Record
  5. 3. Sex
  6. Add'l Death Certificate Identifying Information:
    ONLY Submit this information for Death Certificates
  7. Please provide the last 4 digits, only.

  8. 4. Place of Birth or Death
  9. 5. Full name of Father
  10. 6. Mother's Full Maiden Name
  11. Warning:
    The penalty for knowingly making a false statement on this form can be 2-10 years in prison and a fine up to $10,000.
  13. Birth records are confidential for 75 years and death for 25 years; therefore, issuance is restricted. Administrative rules require that on restricted records, all identifying information (items 1-6), relationship (item 10), and purpose (item 11) be provided in order to issue the record.
  14. Please initial to acknowledge statement
  15. Leave This Blank: