Email
Current Mailing Address
ZIP
Last Name
First Name
Vital Records Request
Daytime Phone #
Applicant Details
Current Mailing Address (must match address on ID)
City
{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[APHONE]}
{[AWEBSITE]}
Middle Name
State
  • Instructions
  • Request
  • Birth
  • Marriage, Civil Union, Domestic Partnership
  • Death
  • Submit

Proof of Relationship

 

To get a certified copy you must provide proof of your relationship to the person listed on the vital record and the proof must establish you are one of the following: 

  • The subject of the record 
  • The subject’s parent, legal guardian or legal representative 
  • The subject’s spouse/civil union or domestic partner; child, grandchild or sibling, if of legal age 
  • A state or federal agency for official purposes
  • Pursuant to court order

Proof of Relationship 

If you are requesting a certified copy

  • your parent’s or sibling’s vital record you must provide a copy of your birth certificate to show you are the child or sibling of the person whose record you are requesting. 
  • your grandparent’s vital record you must establish that you are the person’s grandchild by providing proof that links the name on your ID to the name of the grandparent.

For example, if you changed your last name after marriage/civil union and want a grandparent’s vital record, you must: 

  1. Provide your marriage/civil union certificate to show your name at birth, 
  2. Provide your birth certificate to identify your parent, and 
  3. Provide the parent’s birth certificate to identify the grandparent. 

If you are not a person qualified to get a certified copy of a record 

  • but you are helping a person eligible to receive a vital record obtain a copy of a record they are eligible to receive

you must show your valid ID and a notarized, written release authorizing you to get the record on that person’s behalf including their proof of relationship to the subject of the record.

Veteran's Benefits
What is the purpose of your request * (select as many as necessary)
Other (specify)
Medicare
Request for
Social Security Card/Benefits
Type of record
Welfare/Disability
Mail or Pick Up
Relationship to person on record
Driver's License
School/Sports
Passport
New Name
County
Where was the Child Born?
Name of Child's Parents (name given at birth or on birth certificate / Maiden Name)
Last Name
Middle Name
Last Name
First Name
If the Child's Name was changed please indicate:
Describe Change
Last Name
Parent B First Name
Middle Name
City
Middle Name
Provide Name Given to Child at Birth
Parent A First Name
Date of Birth
State
How many copies?
Last Name
State
Last Name
County
City
Middle Name
How many copies?
Middle Name
Spouse B First Name
Where did the Event take place?
Date of Event
Spouse A First Name
Name of Spouses (name given at birth or on birth certificate / Maiden Name)
Name of Decedent's Parents (name given at birth or on birth certificate / Maiden Name)
Date of Death
First Name
Parent A First Name
Last Name
Last Name
Middle Name
Where did the Decedent pass away?
Middle Name
Last Name
Middle Name
County
Provide Name of Decedent
State
Parent B First Name
City
How many copies?
Type Full Name :
Sign With Hand
By signing, I hereby certify that I am the applicant named above and that I am authorized to request a certified copy of the record for the above named individual. I understand that penalties are described by law for misrepresentation on this request.
Applicant Signature
Certification
Are you Applying in Person?
Please attach an I.D./Passport/Birth certificate and any supporting documents.
Amount Due
Fee Schedule
The amount due is $15.00 for The 1st Certified Copy and $5 for EACH Additional Certified Copy.
Required Documents