This authorization letter appoints a family representative to acquire a Certificate of No Marriage on behalf of the author. Explore an example of an authorization letter for PSA that can be customized to your needs.Download this document in Word format for free. (Name of Parent) (Name of Representative) to claim a copy of Authenticated PSA Birth Certificate of my child . This written authorization is effective the date signed and will remain in effect for a THREE-YEAR period from the date signed below. Owner's Name (Please Print). Tighten up requirements for obtaining authorization to fill a prescription when it is denied because it has been "refilled too soon.