(Name of Parent) (Name of Representative) to claim a copy of Authenticated PSA Birth Certificate of my child . You may obtain a certified copy (or copies) of a birth, death, or marriage certificate from the Riverside County Clerk-Recorder.Give all the information you have available for the identification of the record. Find below, an example of authorization letter for PSA to adapt to your personnal needs. You can also download this document in word format. The Offeror must fill out the following blocks on the form: (1). Block 8, as instructed on the form. (2). Once the form is filled out, send it to the Appeals Coordinator at your Regional Headquarters. Other disorders, eye injuries, and birth defects can also cause vision loss. Executive Director to execute a First Amendment to the.