Certificate of Adoption - BUDGET ZZ 708-153

SECTION 1
The information in this section relates to the child’s information at birth. Enter the name of the child prior to adoption in
item 1. This information must be supplied to enable us to locate the adoptee’s original certificate of birth.

SECTION 2
Item 11 must show the full name of the child as it should be after adoption. Items 12-30 relate to personal information of
the adoptive parents. The responses in these items should be the information as of the date of the adoptees birth
(item 2). This information will be transferred to the NEW certificate of birth for the adopted child.
If this is a step-parent adoption, the information concerning the natural parent MUST also be furnished.
If a NEW certificate is to be prepared, mark “YES” in item 13.
The signature of either the adoptive mother or adoptive father must appear in item 27 verifying the information in
Section 2.

SECTION 3
Complete items 31 through 45 for any person whose consent was required or waived under Chapter 162, Texas Family
Code. This information is required for inclusion in the Central Adoption Registry. All applicable blocks must be
completed. If any or all of the information in items 37 through 45 are not applicable, leave the item(s) blank.
If more than one father is identified and consents to the adoption, list the additional “father” information in an alternate
section. Use the “Guardian’s Name” or “Other Person” fields if not needed otherwise. Mark through the printed title in
the item, write “father”, and complete the blanks as required.
Enter the name, mailing address and telephone number of the attorney of record in items 46-48.
Enter the information relating to the child placing agency in items 49-52, if applicable.
In items 53-55 enter the information relating to the adoption registry maintaining the information on this adoption,
if applicable.

SECTION 4
This section MUST be completed by the clerk of the court granting the adoption. If Section 4 is not completed by the
clerk of the court granting the adoption, a CERTIFIED COPY of the final decree of adoption MUST be attached to the
certificate of adoption form.

MAIL THE PROPERLY COMPLETED CERTIFICATE OF ADOPTION WITH THE
**APPROPRIATE FEES TO:
TEXAS VITAL STATISTICS
DEPARTMENT OF STATE HEALTH SERVICES
PO BOX 12040
AUSTIN TX 78711-2040

**EXPLANATION OF FEES:
The Texas Vital Statistics Unit is now collecting the CAR funds (Central Adoption Registry), as required by Chapter
§108.006(b) of the Family Code. These fees are to be submitted along with the additional filing fees and certified copy
fees collected by the Unit.
A $15.00 CAR (Central Adoption Registry) FUND FEE IS REQUIRED ON EACH ADOPTION DECREE GRANTED IN
TEXAS.
IF THE CHILD WAS BORN IN TEXAS OR A FOREIGN COUNTRY AND A NEW BIRTH CERTIFICATE BASED UPON
ADOPTION MUST BE FILED, A FEE OF $25.00 IS REQUIRED.
TO RECEIVE ONE CERTIFIED COPY OF THE NEW BIRTH RECORD, PLEASE INCLUDE AN ADDITIONAL FEE OF
$22.00.
THE TOTAL FEE OF $62.00 MAY BE SUBMITTED WITH ONE CHECK, PAYABLE TO TEXAS VITAL STATISTICS.
IF THE CHILD WAS BORN IN ANOTHER STATE AND THE ADOPTION WAS GRANTED IN TEXAS, ONLY THE
$15.00 CAR FUND IS REQUIRED.