Get Ph 3343 2015-2024

3. Mail to st Andrew Johnson Tower 1 Floor 710 James Robertson Parkway Nashville TN 37243 PH 3343 Rev. 06/15 RDA 10112. TENNESSEE DEPARTMENT OF HEALTH OFFICE OF VITAL RECORDS NOTIFICATION OF ORDER OF PARENTAGE AND APPLICATION FOR A NEW BIRTH CERTIFICATE Tennessee Code Annotated Sections 36-2-313 and 68-3-310 Name of Court Today s Date County of City of State of Docket Number Date of Decree SECTION I INFORMATION CONCERNING CHILD Name of Child Prior to Court Order Social Security Number Date of Birth Place of Birth CITY COUNTY Sex STATE Name of Child As Determined by Court First Middle Last FATHER OF CHILD Full Name Full Legal Name Date of Birth Full Maiden Name Birthplace STATE OR FOREIGN COUNTRY Residential Address City State Zip Code Mailing Address if different Home Telephone Number Driver s License Number Employer Employer s Address Employer s Telephone Number Health Insurance Policy Number INSTRUCTIONS 1. A new certificate of birth will be prepared in accordance with the law upon the completion and submission of this form and a certified copy of the court s order of parentage. 2. Enclose the 30. 00 fee required for preparation and issuance of a new birth certificate. Make check payable to Tennessee Vital Records. TENNESSEE DEPARTMENT OF HEALTH OFFICE OF VITAL RECORDS NOTIFICATION OF ORDER OF PARENTAGE AND APPLICATION FOR A NEW BIRTH CERTIFICATE Tennessee Code Annotated Sections 36-2-313 and 68-3-310 Name of Court Today s Date County of City of State of Docket Number Date of Decree SECTION I INFORMATION CONCERNING CHILD Name of Child Prior to Court Order Social Security Number Date of Birth Place of Birth CITY COUNTY Sex STATE Name of Child As Determined by Court First Middle Last FATHER OF CHILD Full Name Full Legal Name Date of Birth Full Maiden Name Birthplace STATE OR FOREIGN COUNTRY Residential Address City State Zip Code Mailing Address if different Home Telephone Number Driver s License Number Employer Employer s Address Employer s Telephone Number Health Insurance Policy Number INSTRUCTIONS 1. A new certificate of birth will be prepared in accordance with the law upon the completion and submission of this form and a certified copy of the court s order of parentage. A new certificate of birth will be prepared in accordance with the law upon the completion and submission of this form and a certified copy of the court s order of parentage. 2. Enclose the 30. 00 fee required for preparation and issuance of a new birth certificate. Make check payable to Tennessee Vital Records. TENNESSEE DEPARTMENT OF HEALTH OFFICE OF VITAL RECORDS NOTIFICATION OF ORDER OF PARENTAGE AND APPLICATION FOR A NEW BIRTH CERTIFICATE Tennessee Code Annotated Sections 36-2-313 and 68-3-310 Name of Court Today s Date County of City of State of Docket Number Date of Decree SECTION I INFORMATION CONCERNING CHILD Name of Child Prior to Court Order Social Security Number Date of Birth Place of Birth CITY COUNTY Sex STATE Name of Child As Determined by Court First Middle Last FATHER OF CHILD Full Name Full Legal Name Date of Birth Full Maiden Name Birthplace STATE OR FOREIGN COUNTRY Residential Address City State Zip Code Mailing Address if different Home Telephone Number Driver s License Number Employer Employer s Address Employer s Telephone Number Health Insurance Policy Number INSTRUCTIONS 1. A new certificate of birth will be prepared in accordance with the law upon the completion and submission of this form and a certified copy of the court s order of parentage. 2. Enclose the 30. 00 fee required for preparation and issuance of a new birth certificate. Make check payable to Tennessee Vital Records. .