{ "document_id": 266, "filename": "33953535-b2ff-4cae-823a-5a684cb30b37_e37980bb-6eef-4d28-99fd-ad77adf6117f_Pasadena-Birth-Certificate-Application-2017-artifacted.pdf", "engine": "paddleocr_vl", "source_run_id": 391, "generated_at": "2026-08-21T08:33:19+00:00", "page_count": 2, "counts_by_type": { "figure": 1, "footer": 4, "form_field": 20, "formula": 1, "header": 1, "heading": 7, "list": 3, "list_item": 12, "table": 2, "table_cell": 22, "text": 24, "title": 1 }, "timings": { "total_ms": 323, "structure_ms": 288, "text_layer_ms": 14, "build_ms": 15 }, "pages": [ { "document_id": 266, "page": 1, "width_pt": 612, "height_pt": 792, "engine": "paddleocr_vl", "source_run_id": 391, "item_count": 60, "counts_by_type": { "figure": 1, "footer": 2, "form_field": 13, "header": 1, "heading": 2, "list": 1, "list_item": 6, "table": 2, "table_cell": 22, "text": 9, "title": 1 }, "build_ms": 10, "items": [ { "id": "p1.1", "order": 1, "type": "header", "bbox": { "l": 19.92, "t": 773.28, "r": 134.64, "b": 761.28 }, "text": "(PLEASE PRINT CLEARLY)", "attrs": { "block_label": "header" } }, { "id": "p1.2", "order": 2, "type": "figure", "bbox": { "l": 218.64, "t": 778.32, "r": 414.24, "b": 731.28 }, "text": "", "attrs": { "role": "page_header", "block_label": "header_image" } }, { "id": "p1.3", "order": 3, "type": "title", "bbox": { "l": 215.81, "t": 741.54, "r": 414.169783, "b": 731.064 }, "text": "BIRTH CERTIFICATE APPLICATION FORM", "attrs": { "recovered_from": "text_layer" } }, { "id": "p1.4", "order": 4, "type": "text", "bbox": { "l": 15.6, "t": 716.88, "r": 590.88, "b": 675.12 }, "text": "Birth certificates may be purchased as long as the birth occurred in the incorporated areas of the City of Pasadena. If we cannot identify the record based on the information provided, fees will be retained and a “Letter of No Record” will be issued. Fees are non-refundable, even if the record is not found. You will be asked to present a valid photo ID for all in-person requests." }, { "id": "p1.5", "order": 5, "type": "text", "bbox": { "l": 29.52, "t": 669.36, "r": 116.16, "b": 651.84 }, "text": "Certified Copy", "children": [ { "id": "p1.5.1", "order": 6, "type": "form_field", "bbox": { "l": 35.99974, "t": 666.77162, "r": 46.9735, "b": 652.75082 }, "text": "", "attrs": { "field_kind": "radio", "label": "Certified Copy", "source": "glyph", "label_source": "parent_text", "label_ref": "p1.5", "text_offset": 0, "text_span": 0 } } ] }, { "id": "p1.6", "order": 7, "type": "text", "bbox": { "l": 47.76, "t": 651.84, "r": 247.44, "b": 640.56 }, "text": "You may establish identity with this type of copy" }, { "id": "p1.7", "order": 8, "type": "text", "bbox": { "l": 329.52, "t": 668.88, "r": 439.44, "b": 651.84 }, "text": "Informational Copy", "children": [ { "id": "p1.7.1", "order": 9, "type": "form_field", "bbox": { "l": 335.81006, "t": 666.77162, "r": 346.78382, "b": 652.75082 }, "text": "", "attrs": { "field_kind": "radio", "label": "Informational Copy", "source": "glyph", "label_source": "parent_text", "label_ref": "p1.7", "text_offset": 0, "text_span": 0 } } ] }, { "id": "p1.8", "order": 10, "type": "text", "bbox": { "l": 348.48, "t": 652.08, "r": 558.72, "b": 640.32 }, "text": "You may NOT establish identity with this type copy" }, { "id": "p1.9", "order": 11, "type": "heading", "bbox": { "l": 18.96, "t": 627.6, "r": 287.04, "b": 615.36 }, "text": "1. BIRTH CERTIFICATE INFORMATION (REGISTRANT)", "attrs": { "block_label": "paragraph_title" } }, { "id": "p1.10", "order": 12, "type": "text", "bbox": { "l": 497.28, "t": 626.4, "r": 592.08, "b": 614.88 }, "text": "No. of copies_____", "children": [ { "id": "p1.10.1", "order": 13, "type": "form_field", "bbox": { "l": 499.3003, "t": 625.6599, "r": 591.6423, "b": 614.6199 }, "text": "", "attrs": { "field_kind": "text", "label": "No. of copies_____", "source": "blank_line", "label_source": "parent_text", "label_ref": "p1.10" } } ] }, { "id": "p1.11", "order": 14, "type": "text", "bbox": { "l": 37.92, "t": 612.96, "r": 396, "b": 601.2 }, "text": "Please wait 3 weeks from the date of the event before submitting your request." }, { "id": "p1.12", "order": 15, "type": "table", "bbox": { "l": 16.8, "t": 601.68, "r": 594.24, "b": 434.4 }, "text": "", "attrs": { "block_label": "table", "n_rows": 4, "n_cols": 4, "integrity": { "cells_checked": 13, "cells_flagged": 0 } }, "children": [ { "id": "p1.12.1", "order": 16, "type": "table_cell", "bbox": { "l": 25.91992, "t": 597.8156799999999, "r": 74.479163, "b": 587.93488 }, "text": "First Name", "attrs": { "row": 0, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "column_header": true, "header_source": "pdf" } }, { "id": "p1.12.2", "order": 17, "type": "table_cell", "bbox": { "l": 201.5, "t": 597.8156799999999, "r": 262.208862, "b": 587.93488 }, "text": "Middle Name", "attrs": { "row": 0, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true, "column_header": true, "header_source": "pdf" } }, { "id": "p1.12.3", "order": 18, "type": "table_cell", "bbox": { "l": 351.91, "t": 597.8156799999999, "r": 498.670221, "b": 587.93488 }, "text": "Last Name (Name Given at Birth)", "attrs": { "row": 0, "col": 2, "rowspan": 1, "colspan": 2, "bbox_refit": true, "column_header": true, "header_source": "pdf" } }, { "id": "p1.12.4", "order": 19, "type": "table_cell", "bbox": { "l": 23.4, "t": 558.8156799999999, "r": 156.928813, "b": 548.93488 }, "text": "Name of Hospital in Pasadena", "attrs": { "row": 1, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p1.12.5", "order": 20, "type": "table_cell", "bbox": { "l": 201.5, "t": 558.8156799999999, "r": 335.901608, "b": 520.6006199999999 }, "text": "Was there an adoption, amendment or name change? □Yes □No", "attrs": { "row": 1, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "children": [ { "id": "p1.12.5.1", "order": 21, "type": "form_field", "bbox": { "l": 204.01992, "t": 534.62142, "r": 230.1939, "b": 520.6006199999999 }, "text": "", "attrs": { "field_kind": "radio", "label": "Yes", "source": "glyph", "row": 1, "col": 1, "rowspan": 1, "colspan": 1, "label_source": "parent_text", "label_ref": "p1.12.5", "text_offset": 49, "text_span": 1 } }, { "id": "p1.12.5.2", "order": 22, "type": "form_field", "bbox": { "l": 237.634635, "t": 534.62142, "r": 261.448037, "b": 520.6006199999999 }, "text": "", "attrs": { "field_kind": "radio", "label": "No", "source": "glyph", "row": 1, "col": 1, "rowspan": 1, "colspan": 1, "label_source": "parent_text", "label_ref": "p1.12.5", "text_offset": 54, "text_span": 1 } } ] }, { "id": "p1.12.6", "order": 23, "type": "table_cell", "bbox": { "l": 351.91, "t": 558.8156799999999, "r": 395.585653, "b": 520.6006199999999 }, "text": "Sex □Female □Male", "attrs": { "row": 1, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "children": [ { "id": "p1.12.6.1", "order": 24, "type": "form_field", "bbox": { "l": 351.91, "t": 548.09172, "r": 395.585653, "b": 534.07092 }, "text": "", "attrs": { "field_kind": "radio", "label": "Female", "source": "glyph", "row": 1, "col": 2, "rowspan": 1, "colspan": 1, "label_source": "parent_text", "label_ref": "p1.12.6", "text_offset": 4, "text_span": 1 } }, { "id": "p1.12.6.2", "order": 25, "type": "form_field", "bbox": { "l": 351.91, "t": 534.62142, "r": 385.627456, "b": 520.6006199999999 }, "text": "", "attrs": { "field_kind": "radio", "label": "Male", "source": "glyph", "row": 1, "col": 2, "rowspan": 1, "colspan": 1, "label_source": "parent_text", "label_ref": "p1.12.6", "text_offset": 12, "text_span": 1 } } ] }, { "id": "p1.12.7", "order": 26, "type": "table_cell", "bbox": { "l": 475.63, "t": 558.8156799999999, "r": 532.872102, "b": 548.93488 }, "text": "Date of Birth", "attrs": { "row": 1, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p1.12.8", "order": 27, "type": "table_cell", "bbox": { "l": 23.4, "t": 517.98568, "r": 175.797551, "b": 508.10488 }, "text": "Mother/Father/Parent First Name", "attrs": { "row": 2, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p1.12.9", "order": 28, "type": "table_cell", "bbox": { "l": 201.5, "t": 517.98568, "r": 262.205737, "b": 508.10488 }, "text": "Middle Name", "attrs": { "row": 2, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p1.12.10", "order": 29, "type": "table_cell", "bbox": { "l": 351.91, "t": 517.98568, "r": 581.980511, "b": 508.10488 }, "text": "Last Name (Before Marriage/Domestic Partnership)", "attrs": { "row": 2, "col": 2, "rowspan": 1, "colspan": 2, "bbox_refit": true } }, { "id": "p1.12.11", "order": 30, "type": "table_cell", "bbox": { "l": 23.4, "t": 474.90568, "r": 175.797551, "b": 465.02488 }, "text": "Mother/Father/Parent First Name", "attrs": { "row": 3, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p1.12.12", "order": 31, "type": "table_cell", "bbox": { "l": 201.5, "t": 474.90568, "r": 262.205737, "b": 465.02488 }, "text": "Middle Name", "attrs": { "row": 3, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p1.12.13", "order": 32, "type": "table_cell", "bbox": { "l": 351.91, "t": 474.90568, "r": 581.980511, "b": 465.02488 }, "text": "Last Name (Before Marriage/Domestic Partnership)", "attrs": { "row": 3, "col": 2, "rowspan": 1, "colspan": 2, "bbox_refit": true } } ] }, { "id": "p1.13", "order": 33, "type": "heading", "bbox": { "l": 19.92, "t": 427.2, "r": 243.36, "b": 414.48 }, "text": "2. APPLICANT INFORMATION (REQUESTOR)", "attrs": { "block_label": "paragraph_title" } }, { "id": "p1.14", "order": 34, "type": "table", "bbox": { "l": 16.08, "t": 413.52, "r": 589.92, "b": 295.2 }, "text": "", "attrs": { "block_label": "table", "n_rows": 3, "n_cols": 3, "integrity": { "cells_checked": 9, "cells_flagged": 0 } }, "children": [ { "id": "p1.14.1", "order": 35, "type": "table_cell", "bbox": { "l": 23.4, "t": 410.58568, "r": 71.965102, "b": 400.70488 }, "text": "First Name", "attrs": { "row": 0, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "column_header": true, "header_source": "pdf" } }, { "id": "p1.14.2", "order": 36, "type": "table_cell", "bbox": { "l": 239.45, "t": 410.58568, "r": 300.126049, "b": 400.70488 }, "text": "Middle Name", "attrs": { "row": 0, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true, "column_header": true, "header_source": "pdf" } }, { "id": "p1.14.3", "order": 37, "type": "table_cell", "bbox": { "l": 374.35, "t": 410.58568, "r": 421.446761, "b": 400.70488 }, "text": "Last Name", "attrs": { "row": 0, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true, "column_header": true, "header_source": "pdf" } }, { "id": "p1.14.4", "order": 38, "type": "table_cell", "bbox": { "l": 23.4, "t": 368.34568, "r": 173.466996, "b": 358.46488 }, "text": "Mailing Address (Number, Street)", "attrs": { "row": 1, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p1.14.5", "order": 39, "type": "table_cell", "bbox": { "l": 239.45, "t": 368.34568, "r": 286.557782, "b": 358.46488 }, "text": "Apt #/Unit", "attrs": { "row": 1, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p1.14.6", "order": 40, "type": "table_cell", "bbox": { "l": 374.35, "t": 368.34568, "r": 461.058394, "b": 358.46488 }, "text": "Telephone Number ( )", "attrs": { "row": 1, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p1.14.7", "order": 41, "type": "table_cell", "bbox": { "l": 23.4, "t": 327.40568, "r": 40.52304, "b": 317.52488 }, "text": "City", "attrs": { "row": 2, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p1.14.8", "order": 42, "type": "table_cell", "bbox": { "l": 239.45, "t": 327.40568, "r": 262.70024, "b": 317.52488 }, "text": "State", "attrs": { "row": 2, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p1.14.9", "order": 43, "type": "table_cell", "bbox": { "l": 374.35, "t": 327.40568, "r": 413.447103, "b": 317.52488 }, "text": "ZIP Code", "attrs": { "row": 2, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true } } ] }, { "id": "p1.15", "order": 44, "type": "text", "bbox": { "l": 18.96, "t": 292.32, "r": 591.84, "b": 235.44 }, "text": "Per California State Law, Health and Safety Code, Section 103526 (c), permits only authorized persons as defined below to receive certified copies of Birth Records. Those who are not authorized by law to receive a certified copy will receive a certified informational copy marked “Informational, Not a Valid Document to Establish Identity.” Request for an informational copy do not require a sworn statement and do not require an item to be selected from the list below." }, { "id": "p1.16", "order": 45, "type": "text", "bbox": { "l": 19.2, "t": 226.8, "r": 171.84, "b": 214.8 }, "text": "To receive a Certified Copy, I am:" }, { "id": "p1.17", "order": 46, "type": "list", "bbox": { "l": 18.96, "t": 213.36, "r": 592.8, "b": 39.36 }, "text": "", "attrs": { "item_count": 6 }, "children": [ { "id": "p1.17.1", "order": 47, "type": "list_item", "bbox": { "l": 18.96, "t": 213.36, "r": 589.2, "b": 188.16 }, "text": "○ The registrant (person listed on the certificate) or a parent or legal guardian of the registrant. (Legal guardian must provide documentation.)", "children": [ { "id": "p1.17.1.1", "order": 48, "type": "form_field", "bbox": { "l": 21.60004, "t": 214.44172000000003, "r": 32.5738, "b": 200.42092000000002 }, "text": "", "attrs": { "field_kind": "radio", "label": "○ The registrant (person listed on the certificate) or a parent or legal guardian of the registrant. (Legal guardian must provide documentation.)", "source": "glyph", "label_source": "parent_text", "label_ref": "p1.17.1", "text_offset": 0, "text_span": 1 } } ] }, { "id": "p1.17.2", "order": 49, "type": "list_item", "bbox": { "l": 19.2, "t": 186.24, "r": 592.8, "b": 147.84 }, "text": "○ A party entitled to receive the record as a result of a court order or an attorney or a licensed adoption agency seeking the birth record in order to comply with the requirements of Section 3140 or 7603 of the Family Code. (Please include a copy of the court order.)", "children": [ { "id": "p1.17.2.1", "order": 50, "type": "form_field", "bbox": { "l": 21.59994, "t": 187.65152, "r": 32.5737, "b": 173.63072 }, "text": "", "attrs": { "field_kind": "radio", "label": "○ A party entitled to receive the record as a result of a court order or an attorney or a licensed adoption agency seeking the birth record in order to comply with the requirements of Section 3140 or 7603 of the Family Code. (Please include a copy of the court order.)", "source": "glyph", "label_source": "parent_text", "label_ref": "p1.17.2", "text_offset": 0, "text_span": 1 } } ] }, { "id": "p1.17.3", "order": 51, "type": "list_item", "bbox": { "l": 18.96, "t": 146.16, "r": 567.36, "b": 107.28 }, "text": "○ A member of a law enforcement agency or a representative of another government agency, as provided by law, who is conducting official business. (Companies representing a government agency must provide authorization from the government agency.)", "children": [ { "id": "p1.17.3.1", "order": 52, "type": "form_field", "bbox": { "l": 21.59994, "t": 147.33172000000002, "r": 32.5737, "b": 133.31092 }, "text": "", "attrs": { "field_kind": "radio", "label": "○ A member of a law enforcement agency or a representative of another government agency, as provided by law, who is conducting official business. (Companies representing a government agency must provide authorization from the government agency.)", "source": "glyph", "label_source": "parent_text", "label_ref": "p1.17.3", "text_offset": 0, "text_span": 1 } } ] }, { "id": "p1.17.4", "order": 53, "type": "list_item", "bbox": { "l": 18.96, "t": 105.84, "r": 467.04, "b": 93.12 }, "text": "○ A child, grandparent, grandchild, brother or sister, spouse, or domestic partner of the registrant.", "children": [ { "id": "p1.17.4.1", "order": 54, "type": "form_field", "bbox": { "l": 21.59976, "t": 107.01581999999996, "r": 32.57352, "b": 92.99501999999995 }, "text": "", "attrs": { "field_kind": "radio", "label": "○ A child, grandparent, grandchild, brother or sister, spouse, or domestic partner of the registrant.", "source": "glyph", "label_source": "parent_text", "label_ref": "p1.17.4", "text_offset": 0, "text_span": 1 } } ] }, { "id": "p1.17.5", "order": 55, "type": "list_item", "bbox": { "l": 19.44, "t": 91.92, "r": 555.12, "b": 66.96 }, "text": "An attorney representing the registrant or the registrant's estate, or any person or agency empowered by statute or appointed by a court to act on behalf of the registrant or the registrant's estate.", "children": [ { "id": "p1.17.5.1", "order": 56, "type": "form_field", "bbox": { "l": 21.59976, "t": 93.57601999999997, "r": 32.57352, "b": 79.55521999999996 }, "text": "", "attrs": { "field_kind": "radio", "label": "An attorney representing the registrant or the registrant's estate, or any person or agency empowered by statute or appointed by a court to act on behalf of the registrant or the registrant's estate.", "source": "glyph", "label_source": "parent_text", "label_ref": "p1.17.5", "text_offset": 0, "text_span": 0 } } ] }, { "id": "p1.17.6", "order": 57, "type": "list_item", "bbox": { "l": 18.96, "t": 65.76, "r": 578.64, "b": 39.36 }, "text": "○ Appointed rights in a power of attorney, or an executor of the registrant's estate. (Please include a copy of the power of attorney, or supporting documentation identifying you as executor.)", "children": [ { "id": "p1.17.6.1", "order": 58, "type": "form_field", "bbox": { "l": 21.5997, "t": 66.81592, "r": 32.57346, "b": 52.79512 }, "text": "", "attrs": { "field_kind": "radio", "label": "○ Appointed rights in a power of attorney, or an executor of the registrant's estate. (Please include a copy of the power of attorney, or supporting documentation identifying you as executor.)", "source": "glyph", "label_source": "parent_text", "label_ref": "p1.17.6", "text_offset": 0, "text_span": 1 } } ] } ] }, { "id": "p1.18", "order": 59, "type": "footer", "bbox": { "l": 34.56, "t": 25.44, "r": 82.32, "b": 14.64 }, "text": "Page 1 of 2", "attrs": { "block_label": "number" } }, { "id": "p1.19", "order": 60, "type": "footer", "bbox": { "l": 476.64, "t": 26.16, "r": 540.72, "b": 14.88 }, "text": "Revised 6/2017", "attrs": { "block_label": "footer" } } ] }, { "document_id": 266, "page": 2, "width_pt": 612, "height_pt": 792, "engine": "paddleocr_vl", "source_run_id": 391, "item_count": 38, "counts_by_type": { "footer": 2, "form_field": 7, "heading": 5, "list": 2, "list_item": 6, "text": 16 }, "build_ms": 5, "items": [ { "id": "p2.1", "order": 1, "type": "heading", "bbox": { "l": 19.2, "t": 749.52, "r": 583.92, "b": 736.32 }, "text": "3. 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