Florida Affidavit to Release a Birth Certificate (DH 1958)
Official state formOther requestsForm DH 1958Free downloadLast verified November 10, 2026
Notarized affidavit in which a person entitled to a Florida birth certificate lets another named person obtain it. It is good for one use and needs original signatures. It is sent with birth application DH 726 to the Bureau of Vital Statistics.
Who can use this form
- The child named on the certificate, if 18 or older
- A parent listed on the birth certificate
- A legal guardian (documentation required)
- The legal representative of an eligible person (documentation required)
What to send with it
- Notarized affidavit (notarization in person or online is allowed)
- Application DH 726 completed by the person who will receive the certificate
- Copy of valid photo ID of both the person giving permission and the person receiving the certificate
- Supporting documentation
Where to send it
- Mail to
- FLORIDA DEPARTMENT OF HEALTH BUREAU OF VITAL STATISTICS ATTN: VITAL RECORDS SECTION P.O. BOX 210 JACKSONVILLE, FL 32231-0042
- State fee
- No fee for the affidavit itself. The fees are those of the application it is sent with.
- Typical processing
- Not provided
- Form revision
- 01/2022
- Source
- Official government page