Local Registrar Self-Assessment Survey

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 or contact the Field Services team at (512) 776-3010.

 

 Field Services Representatives 

Field Representative

Region

Phone Number

E-Mail

Victor Farinelli

Manager

(512) 776-7368

victor.farinelli@dshs.state.tx.us

 Gaetan Carpentier

5S & 6 

(512) 776-2598 

 gaetan.carpentier@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

Stephen McCandless

1, 9, & 10 

(512) 776-2611 

stephen.mccandless@dshs.state.tx.us 

Juanita Moshier

4. 5N, & 7

(512) 776-3651

juanita.moshier@dshs.state.tx.us 

Shannon Nagy

8 & 11

(512) 776-2501

shannon.nagy@dshs.state.tx.us

 Anthony Patterson

2 & 3 

(512) 776-2503

anthony.patterson@dshs.state.tx.us 

 Danielle Smith

 8 & 11

 (512) 776-3651

 danielle.smith2@dshs.state.tx.us

Soo Teal

2 & 3

(512) 776-2534

soo.teal@dshs.state.tx.us

 Raven Wrencher

 4, 5N, & 7

 (512) 776-6567

 raven.wrencher@dshs.state.tx.us

  

Last updated November 30, 2016