Civil Registry Document Authorization Letter Form
Use this form to authorize another person or entity to request, receive, or pick up civil registry documents on your behalf.
Applicant Information
Full Name
*
First Name
Middle Name
Last Name
Relationship to Document Holder
Please Select
Self
Parent
Spouse
Child
Sibling
Legal Guardian
Representative
Other
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Authorization Details
Authorized Person Name
*
First Name
Last Name
Relationship or Role
*
Please Select
Parent
Spouse
Child
Sibling
Relative
Attorney-in-Fact
Representative
Other
Civil Registry Document(s) Requested
*
Birth Certificate
Marriage Certificate
Death Certificate
Adoption Record
Civil Registry Extract
Other
Purpose of Authorization
*
Scope of Authority
*
Request documents
Receive documents
Pick up documents
Submit supporting documents
Pay applicable fees
Other
Declaration and Approval
Applicant Signature
*
Submit
Submit
Should be Empty: