{ "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. SWORN STATEMENT* (Must be signed in the presence of the Pasadena Vital Records Staff or a Notary Public.)", "attrs": { "block_label": "paragraph_title" } }, { "id": "p2.2", "order": 2, "type": "text", "bbox": { "l": 20.88, "t": 711.84, "r": 589.2, "b": 684.96 }, "text": "I, ___, declare under penalty of perjury under the laws of the State of California, (Applicant's Printed Name)", "children": [ { "id": "p2.2.1", "order": 3, "type": "form_field", "bbox": { "l": 22.8, "t": 710.9798, "r": 588.744, "b": 699.9398 }, "text": "", "attrs": { "field_kind": "text", "label": "I, ___, declare under penalty of perjury under the laws of the State of California, (Applicant's Printed Name)", "source": "blank_line", "label_source": "parent_text", "label_ref": "p2.2" } } ] }, { "id": "p2.3", "order": 4, "type": "text", "bbox": { "l": 21.6, "t": 671.76, "r": 589.44, "b": 650.4 }, "text": "that I am an authorized person, as defined in California Health and Safety Code Section 103526 (c), and am eligible to receive a" }, { "id": "p2.4", "order": 5, "type": "text", "bbox": { "l": 21.12, "t": 645.12, "r": 344.16, "b": 632.16 }, "text": "certified copy of the birth certificate identified on this application form." }, { "id": "p2.5", "order": 6, "type": "text", "bbox": { "l": 16.56, "t": 604.32, "r": 583.92, "b": 540.24 }, "text": "Subscribed to this___ day of ___, 20___, at ___, (Day) (Month) (City) (State)\n(Applicant's Signature)", "children": [ { "id": "p2.5.1", "order": 7, "type": "form_field", "bbox": { "l": 23.4001, "t": 603.5798, "r": 582.4745, "b": 592.5398 }, "text": "", "attrs": { "field_kind": "text", "label": "Day", "source": "blank_line", "label_source": "parent_text", "label_ref": "p2.5" } }, { "id": "p2.5.2", "order": 8, "type": "form_field", "bbox": { "l": 381.7905, "t": 563.26, "r": 573.5599, "b": 552.22 }, "text": "", "attrs": { "field_kind": "text", "source": "blank_line", "label": "City", "label_source": "parent_text", "label_ref": "p2.5" } } ] }, { "id": "p2.6", "order": 9, "type": "text", "bbox": { "l": 24.72, "t": 537.12, "r": 581.04, "b": 497.28 }, "text": "[p2.6.1]If you are requesting a certified copy by mail, you must have the above statement and the certificate of acknowledgement notarized. Please note: The notary is not certifying the relationship, only that you are the person requesting the copy. Requests for an informational copy do not require your signature to be notarized.", "children": [ { "id": "p2.6.1", "order": 10, "type": "text", "bbox": { "l": 24.72, "t": 537.12, "r": 581.04, "b": 497.28 }, "text": "^{*}", "attrs": { "latex": "^{*}", "inline": true, "text_offset": 0, "text_span": 8, "bbox_estimated": true, "notation": "latex", "alt": "to the power of *", "mathml": "*", "ai_retyped_from": "formula", "ai_reason": "The asterisk footnote marker is plain text, not a formula" } } ] }, { "id": "p2.7", "order": 11, "type": "heading", "bbox": { "l": 22.32, "t": 477.6, "r": 150, "b": 465.84 }, "text": "SUBMITTING APPLICATION", "attrs": { "block_label": "paragraph_title" } }, { "id": "p2.8", "order": 12, "type": "heading", "bbox": { "l": 33.6, "t": 446.16, "r": 75.36, "b": 434.4 }, "text": "By Mail:" }, { "id": "p2.9", "order": 13, "type": "list", "bbox": { "l": 51.12, "t": 432.8452, "r": 586.56, "b": 372.96 }, "text": "", "attrs": { "item_count": 4 }, "children": [ { "id": "p2.9.1", "order": 14, "type": "list_item", "bbox": { "l": 51.6, "t": 432.8452, "r": 586.56, "b": 418.56 }, "text": "• Payment may be made by check or money order made payable to the City of Pasadena Public Health Department." }, { "id": "p2.9.2", "order": 15, "type": "list_item", "bbox": { "l": 51.12, "t": 417.8452, "r": 151.2, "b": 404.33224 }, "text": "Do not mail cash." }, { "id": "p2.9.3", "order": 16, "type": "list_item", "bbox": { "l": 51.12, "t": 402.7253, "r": 302.64, "b": 389.21234 }, "text": "Please provide a self-addressed stamped envelope." }, { "id": "p2.9.4", "order": 17, "type": "list_item", "bbox": { "l": 51.12, "t": 387.6054, "r": 385.68, "b": 372.96 }, "text": "The document(s) will be mailed to you within seven (7) business days." } ] }, { "id": "p2.10", "order": 18, "type": "heading", "bbox": { "l": 33.6, "t": 356.4, "r": 83.52, "b": 345.12 }, "text": "In Person:", "attrs": { "block_label": "paragraph_title" } }, { "id": "p2.11", "order": 19, "type": "list", "bbox": { "l": 50.4, "t": 343.5453, "r": 547.92, "b": 300 }, "text": "", "attrs": { "item_count": 2 }, "children": [ { "id": "p2.11.1", "order": 20, "type": "list_item", "bbox": { "l": 50.88, "t": 343.5453, "r": 316.56, "b": 330 }, "text": "You will be asked to present valid photo identification." }, { "id": "p2.11.2", "order": 21, "type": "list_item", "bbox": { "l": 50.4, "t": 328.5453, "r": 547.92, "b": 300 }, "text": "- Payment may be made with a credit card (American Express, Discover, MasterCard, Visa, Debit) cash or by check/money order made payable to the City of Pasadena Public Health Department." } ] }, { "id": "p2.12", "order": 22, "type": "text", "bbox": { "l": 33.6, "t": 283.2, "r": 391.44, "b": 270.96 }, "text": "Please send or bring your completed application with the appropriate fee(s) to:" }, { "id": "p2.13", "order": 23, "type": "text", "bbox": { "l": 33.6, "t": 260.88, "r": 235.2, "b": 248.4 }, "text": "City of Pasadena Public Health Department" }, { "id": "p2.14", "order": 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