Form DH 743A, Affirmation of Common Child(ren) Born in Florida, is a sworn statement in which two spouses attest that they are the parents of minor children born in Florida, and that the information may be relied upon for the issuance of a marriage license. The Broward County Clerk of Courts publishes the PDF. It is not a request for a Broward County birth certificate: it only asks you to copy each child's details as they appear on one. On this page you can fill out the form online on FillingPDF and download or print the completed PDF; the original lives on the Clerk's website.
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What is DH 743A?
Form DH 743A, Affirmation of Common Child(ren) Born in Florida, is a State of Florida Department of Health, Office of Vital Statistics form on which two spouses swear that they are the parents of the listed minor child(ren) born in Florida, under §741.01, Florida Statutes.
The form has three parts. At the top you enter the Marriage Application Number and, for each spouse, the name, maiden surname if different, date of birth and birthplace. The middle lists up to three children, numbered 1 to 3, each with the name as it appears on the birth certificate, date of birth, birth certificate number if known, and the city and county of birth; the state is preprinted as Florida. The bottom is the oath: both spouses swear and affirm that the information is true and correct and may be relied upon for the issuance of a marriage license, and a Deputy Clerk (or notary) completes the jurat for each spouse.
The venue is preprinted as State of Florida, County of Broward. A banner at the top says the information below is for use by Vital Statistics only and is not to be recorded. The form is edition DH 743A, 01/2015, and cites Florida Administrative Code Rule 64V-1.020.
The form does not issue or request a birth certificate. It records details taken from the children's birth certificates so they can be relied on for a marriage license.
Who needs to file DH 743A?
The form is written for two spouses who are the parents of minor child(ren) born in the State of Florida and who are applying for a marriage license. Both spouses complete their own block, both sign, and each swears the statement before a Deputy Clerk (or notary).
Conditions the form itself sets:
- Only children born in Florida are listed; the state of birth is preprinted as Florida.
- Up to three children fit on the form, each with the name as it appears on the birth certificate.
- The form is tied to a Marriage Application Number, so it goes with a marriage license application already started.
The form does not describe any representative signing for a spouse; the signature line is for each spouse personally. It is not a way to obtain a copy of a birth certificate.
When to file DH 743A
Complete Form DH 743A when you apply for a marriage license and you and your future spouse have minor child(ren) together who were born in Florida. The form carries the Marriage Application Number, so it belongs with a pending marriage license application, and its sworn statement says the information may be relied upon for the issuance of the license. No separate deadline or validity period is printed on the form. The date is written in the sworn block when each spouse signs before the Deputy Clerk (or notary).
Documents you need
- Identification for each spouse, unless the Deputy Clerk (or notary) knows you personally: the form has a choice between Personally Known and Produced identification, and a line for the type of identification produced.
- Your Marriage Application Number: the form asks for it at the top, so have it from your marriage license application.
- Each child's birth certificate details: name as it appears on the birth certificate, date of birth, place of birth and the birth certificate number if known. The form asks you to enter them; it does not ask you to attach the certificate.
How to fill out DH 743A
Enter the Marriage Application Number
At the top, write the Marriage Application Number from your marriage license application. Type or print all information, as the form directs.
Complete the first spouse's details
Enter the spouse's name (First, Middle, Last), the maiden surname if different, the date of birth in mm/dd/yyyy format and the birthplace (State/Country).
Complete the second spouse's details
Repeat the same entries for the other spouse in the second block: name, maiden surname if different, date of birth and birthplace.
List the first child
On line 1, enter the child's name as it appears on the birth certificate, the date of birth (mm/dd/yyyy), the birth certificate number if known, and the city and county of birth. The state is preprinted as Florida.
Add any other children
Use lines 2 and 3 for additional common children, with the same four entries each. Leave unused lines empty.
Fill in the identification choices
For each spouse, mark Personally Known or Produced identification, and enter the Type of Identification Produced if one was produced. The State of Florida and County of Broward are preprinted.
Sign before the Deputy Clerk or notary
Each spouse signs on the Spouse's signature line when swearing the statement, in front of the officer. The Deputy Clerk (or notary) completes the date, signature, printed name and seal in the SWORN block.
Review and download the completed PDF
Check names, dates and the Marriage Application Number against your documents. Download or print the completed PDF from FillingPDF, then follow the channels under How to submit.
How to submit DH 743A
Form DH 743A prints no mailing address, portal or appointment rule, so it follows the marriage license process it supports.
- Where it belongs: with your marriage license application, identified by the Marriage Application Number at the top. The Broward County Clerk of Courts publishes the PDF at https://www.browardclerk.org/PDF/Marriage/AffCommonChildrenForm.pdf.
- The oath: each spouse signs and swears the statement before a Deputy Clerk (or notary), who completes the SWORN block with signature, printed name and seal.
- Delivery: deliver it the way the Broward County Clerk of Courts directs for the marriage license application, and confirm the method with the Clerk before you go.
The banner on the form states that the information is for Vital Statistics use only and is not to be recorded. FillingPDF lets you fill out and download the PDF; submission follows the agency's channels.
Common mistakes to avoid
- Leaving the Marriage Application Number blank; the form asks for it at the top.
- Writing a child's name differently from the way it appears on the birth certificate.
- Listing a child who was not born in Florida; the form covers children born in the State of Florida and the state of birth is preprinted as Florida.
- Skipping the maiden surname line when a spouse's maiden surname differs from the name entered.
- Writing dates in a format other than mm/dd/yyyy.
- Not choosing between Personally Known and Produced identification, or leaving Type of Identification Produced empty when identification was produced.
- Completing the SWORN block yourself; the date, signature, printed name and seal belong to the Deputy Clerk (or notary).
- Having only one spouse sign; the form has a separate signature and sworn block for each spouse.
- Handwriting entries that are hard to read; the form says to type or print the information.
Frequently asked questions
What is Form DH 743A?
Form DH 743A is the Affirmation of Common Child(ren) Born in Florida, a Florida Department of Health, Office of Vital Statistics form. Two spouses swear they are the parents of the listed minor children born in Florida, and the information may be relied upon for issuing a marriage license.
Is this form a Broward County birth certificate?
No. It does not issue or request a Broward County birth certificate. It only asks you to copy each child's details, such as the name as it appears on the birth certificate and the birth certificate number if known, into a sworn statement for a marriage license.
Who has to sign Form DH 743A?
Both spouses. The form has a Spouse's signature line for each, and each signature is sworn to and subscribed before a Deputy Clerk (or notary), who signs, prints their name and adds a seal. The form names no one who may sign on a spouse's behalf.
Do I need ID to complete the affirmation?
The form has a Personally Known OR Produced identification choice for each spouse and a line for the type of identification produced. If the Deputy Clerk or notary does not know you personally, bring identification to show and enter its type.
How many children can I list on Form DH 743A?
Up to three, on lines 1 to 3. Each entry needs the name as it appears on the birth certificate, date of birth, city and county of birth, and the birth certificate number if known. The state of birth is preprinted as Florida.
Can I fill out Form DH 743A online?
Yes, you can fill out the PDF online on FillingPDF and download or print it. FillingPDF is an independent service: it does not file the form or swear it for you, so you still sign before a Deputy Clerk or notary and deliver it through the agency's channels.
Where do I turn in the affirmation of common children?
The form prints no address or portal. It carries a Marriage Application Number and supports the issuance of a marriage license, so deliver it as the Broward County Clerk of Courts directs for your marriage license application, and confirm the method with the Clerk.
What law does Form DH 743A refer to?
The form states that the spouses attest in accordance with §741.01, Florida Statutes, and it cites Florida Administrative Code Rule 64V-1.020. The edition printed on the form is DH 743A, 01/2015.
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