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B0219

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INSTRUCTIONS FOR PAYING BY CREDIT CARD FOR A NON-CERTIFIED COPY OR CERTIFIED COPY
FOR MARRIAGE LICENSE COPIES: COMPLETE SECTIONS 1 AND 2.
FOR PROPERTY, MAP & CONDO RECORDS AND FORECLOSURE NOTICE COPIES: COMPLETE SECTIONS 1 AND 3.
FOR MISC. PERSONAL RECORDS, DD214’S, AND DBA APPLICATION COPIES: COMPLETE SECTIONS 1 AND 4.
**** FOR BIRTH OR DEATH RECORD COPIES, VISIT http://www.cclerk.hctx.net/PersonalRecords.aspx#Vital*****
************************************************************************************************************
FORM SECTION DETAILS
SECTION 1. Please complete Section 1 entirely. If you do not have a fax number or email address, please put “N/A”.
Please select on the appropriate line (Certified or Non-Certified), the type of copy, the number of copies
requested, and how you would like your order delivered to you (faxed, emailed, to be picked up, or mailed).
Note: Certified copies can ONLY be mailed or picked up. Non-certified, plain copies can be emailed, mailed,
faxed or picked up in person.
If you would like both certified and non-certified copies, please select accordingly on the form.
SECTION 2. Please fill out names of both applicants. (First, middle, & last names used at the time of application)
SECTION 3. Please fill out type of document (i.e. Deed of Trust, Warranty Deed, Lien, Abstract of Judgment, etc.).
Please put property address in the address field.
Include Subdivision Name, Section, Lot, and Block, if known. (Located on your tax statement)
Include Grantor (Seller, Borrower or Plaintiff) Name in the Grantor field.
Include Grantee (Current Owner, Lender or Defendant) Name in the Grantee field.
Include the file number and film code number, if known.
Note: If more than one document is needed, please attach a separate page with the information along with this
form. (Do NOT send more than one completed credit card form).
SECTION 4. Include file number and film code, if known.
Include type of document (i.e. Assumed Name/DBA application, Hospital Lien, Misc. Personal Record, etc.).
Include the name on record.
************************************************************************************************************
NOTE: When sending the following credit card form, PLEASE DO NOT include this page of instruction.
Fees are subject to change without notice. Call 713-274-6390 for fee verification and assistance filling out this form
The fees for paper copies are as follows:
Non-Certified Paper Copy - $1.00 per page.
Certified Paper Copy - $5.00 certification fee
per document & $1.00 per page.
Electronic (non-certified) - $1.00 per page.
Map or Condominium Records:
Non-certified - $10.00 per page.
Certified copy - $15.00 per page.
Options to submit the completed form:
Email: ccoinfoFM@cco.hctx.net
Mail: Diane Trautman, Harris County Clerk
Attn: Information Department
P.O. Box 1525
Houston, TX 77251
FAX: 713-437-4868
In Person: At any of our ten (10) locations.
OFFICE OF DIANE TRAUTMAN
COUNTY CLERK, HARRIS COUNTY, TEXAS
INFORMATION AND PUBLIC SERVICE DEPARTMENT
P.O. Box 1525 Houston, TX 77251-1525 PHONE 713-274-6390 FAX (713) 437-4868
ccoInfoFM@cco.hctx.net
Form No. B-02-19 (Rev. 01/01/2019)
FIELDS MARKED WITH * ARE REQUIRED
(SECTION 1) PLEASE PROVIDE REQUESTED PAYMENT INFORMATION
*Name of Requestor: Date:
*Mailing Address:
*City: *State: *Zip:
*Email Address:
*Phone No.: *Fax No.:
*Cardholder Name (If Different from Requestor):
*Credit Card: □ Visa □ MasterCard □ Discover □ American Exp.
There is a 4% surcharge on all services requested by mail, email, phone or fax.
*Card No. ________________________________________________ *Expiration Date: ______/______
*Card Code _______ *Cardholder’s/Authorized User Signature: ________________________________
TYPE OF COPIES AND METHOD OF DELIVERY REQUESTED
□ Certified Copy □ Mail □ Pick up # of Copies:
□ Non-Certified Copy □ Mail □ Pick up □ Fax □ Email # of Copies:
(SECTION 2) FOR MARRIAGE LICENSE COPY
Name of applicant 1: Month/Year:
Name of applicant 2: License/File #:
(SECTION 3) FOR PROPERTY RECORDS, MAPS, & FORECLOSURE COPIES
Document type: File number: Film code:
Address:
Subdivision: Lot: Block: Section:
Grantor: Grantee:
(SECTION 4)FOR PERSONAL RECORDS, DBA & DD214 COPIES
File number: Film code: Date on document:
Document type: Name(s) on document:
For County Clerk Use Only:
Amount: $ Date:
Fees Assessed By:
Copy Order #
Trans #
Requested by: □ fax □ phone □ mail □ email
Cashier:
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B0219

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Completed 20 July 2020

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