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Local Registrar Self-Assessment Survey

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Fill out and print the form.

Local Registrar Self Assessment Survey Print

Mail the completed form, along with all required sample documents, to the following physical address:

Vital Statistics Unit
Attn: Field Services
Mailcode 1966
P.O. Box 149347
Austin, Texas 78714-9347

If you have questions, please contact your field representative.

 Field Services Representatives 

Field Representative

Region

Phone Number

E-Mail

Victor Farinelli

Manager

(512) 776-7368

victor.farinelli@dshs.state.tx.us

Derek Johnson

5S & 6

(512) 776-2530

derek.johnson@dshs.state.tx.us

Mike McNutt

1, 9, & 10

(512) 776-2580

mike.mcnutt@dshs.state.tx.us

Patrick Moore

8 & 11

(512) 776-3651

patrickc.moore@dshs.state.tx.us

Susanna Sparkman

4, 5N, & 7

(512) 776-6567

susanna.sparkman@dshs.state.tx.us

Soo Teal

2 & 3

(512) 776-2534

soo.teal@dshs.state.tx.us

  

Last updated August 12, 2015