Birth Certificate Request - Forms Creator

Birth Certificate Request

Step 1 of 8

- User Email*
- What is the date of this letter?
- Date Mailed:
  
  MM slash DD slash YYYY
- What is the name and address of the person making this request?
- Full Name:
- Address:
  
  City
  
  State
  
  ZIP Code
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- What is the name and address of the office that will handle your request?
- Your request should be sent to the Office of Vital Statistics in the county and state in which the person whose name appears on the certificate was born. Please check the office’s website or call the local courthouse to determine if any additional paperwork must be submitted along with this request.
- Name of Office:
- Name of Contact Person:
- Title of Contact Person:
- Salutation of Letter (examples: Dear Mr. Smith, To Whom It May Concern, Dear Sir or Madam):
- Office Address:
  
  Office City:
  
  Office State:
  
  Office ZIP Code:
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- How many copies of the birth certificate would you like to request?
- Number of Copies (written):
- Number of Copies (numerical):
- Are you requesting your own birth certificate?
- Requesting Your Own Birth Certificate?:
  - Yes
  - No
- Your Name as it Appears on Certificate:
- Your Gender:
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- What is the name of the person whose birth certificate you are requesting?
- Full Name of Person as it Appears on Certificate:
- Person's Gender:
- Your Relationship to Person (mother, father, etc.):
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- When and where was the person whose name appears on the certificate born?
- Date of Birth:
  
  MM slash DD slash YYYY
- Place of Birth (name of hospital or street address of place of birth):
- Birth City:
  
  Birth State:
  
  Birth County:
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- Who are the parents of the person whose name appears on the certificate?
- Full Name of Father (first, middle, last, suffix):
- Full Name of Mother (first, middle, last, suffix):
- Maiden Name of Mother:
- What is the reason for this request?
- This certificate is being requested for the purpose of: (example: compiling a family scrapbook):
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- How will you pay for the requested certificate(s)?
- Not all forms of payment may be accepted by your Office of Vital Statistics; consult the office for details. Note that you should include a stamped and self-addressed envelope with your payment.
- Type of Payment:
- Amount of Payment ($):
- How would you prefer that the Office of Vital Statistics contact you?
- You must complete at least one of the fields below. Remember to sign the letter once complete.
- Email Address:
- Telephone Number (###-###-####):
- Fax Number (###-###-####):
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