Puerto Rico Vital Records

Please be advised that I                                                   who resides at

the following address:




give my full permission to A Birth Certfificate.net to obtain my birth certificate for me.

If you have any questions please contact me at the following numbers:

Home: (     )        -

Work: (     )        -

Cell: (     )        -

Thank you,


(Notary Seal)                                                              X                                                        
                                                                                                      (Notary Signature)