Florida Certificate of Nonviable Birth Application (DH8001)
Official state formStillbirth and pregnancy lossForm DH8001Free downloadLast verified November 10, 2026
Application to order a certification of a Certificate of Nonviable Birth (a pregnancy loss in the 10th to 19th week) after the health care practitioner has filed it. Page 2 is a notarized affidavit to add a name to the record. It goes to the Bureau of Vital Statistics.
Who can use this form
- The record is public: any applicant of legal age may apply, according to the office's web page.
- Parentage information is released only to the parent or parents listed on the record, with valid ID.
- The affidavit to add a name must be signed by the parent or parents listed, before a notary.
- Parents must first ask a nurse or midwife to file the certificate.
What to send with it
- Completed and signed application
- Copy of valid ID, if applicable
- Notarized affidavit on page 2, if adding a name
- Check or money order payable to Vital Statistics
Where to send it
- Mail to
- DEPARTMENT OF HEALTH BUREAU OF VITAL STATISTICS ATTN: VITAL RECORDS SECTION P.O. BOX 210 JACKSONVILLE, FL 32231-0042
- State fee
- $9.00 for the first certification (non-refundable search fee); $4.00 for each additional certification; $20.00 amendment fee to add a name (includes one certification); optional $10 rush fee. The office's web page also lists $2.00 per additional year searched (maximum $50), which the form does not print.
- Typical processing
- Not provided
- Form revision
- 07/2017
- Source
- Official government page