Birth Certificate Application Form

Retrieving Data

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Birth information of the person on record

Please complete the birth information below as shown on the birth record. If you are applying on behalf of someone else (i.e. your child), please enter their birth information here.

Date of birth

Full name of the person on record

Please enter Full name at birth of the person on record as shown on the Birth Certificate.

Your relationship with person on record

Mother/Parent’s full name

Please enter the Mother/Parent’s full name as shown on Birth Certificate of the person on record.

Father/Parent’s full name

Please enter the Father/Parent’s full name as shown on Birth Certificate of the person on record.

Contact information

Please enter your full name as shown on your ID and your contact information.

Delivery information

Please enter the physical address where you want the certificate to be delivered.

Standard or Premium Processing?

Choose standard to download, print, and send your application, or choose premium if you want us to take care of your application as fast as possible. Download, print, and send your application by following step-by step instructions.

DOWNLOAD ONLY

$49
$49

Download, print, and send your application by following step-by step instructions.

Download your prepared application and submit it to the Health Department by following step-by step instructions.

Application preparation only. State fees NOT included.

Preparation only. State fees NOT included.

COMPLETE APPLICATION

Most Popular
$99
$99

We submit your application to the Health Department. It’s priority-processed and mailed to you as fast as possible when it’s ready.

Priority processing. Fast delivery. State fees included.

Fast processing and delivery. State fees included.

Shipping Method
$0
Extra Copies
($12 each)
$0
99

Total amount: $99