Louisiana Application for Birth Resulting in Stillbirth Certificate (PHS 520D)
Official state formStillbirth and pregnancy lossForm PHS 520DFree downloadLast verified November 12, 2026
Mail application for a Louisiana Birth Resulting in Stillbirth Certificate. The mother or father applies with a photo ID. It goes to the Vital Records Registry in New Orleans. It is not for live birth or death certificates.
Who can use this form
- The mother or the father of the stillborn child.
- The applicant must submit a copy of a state issued or federal photo ID.
What to send with it
- The completed and signed application.
- A copy of the applicant's federal or state photo ID.
- A check or money order. Do not send cash.
- The form lists a complimentary first copy and $15.00 for each additional copy, plus a $0.50 state charge per mail order.
Where to send it
- Mail to
- Vital Records Registry P.O. Box 60630 New Orleans, LA 70160
- State fee
- One complimentary copy (no fee). $15.00 for each additional copy. Mail orders add a $0.50 state charge per transaction. As printed on the form, which carries an old Department of Health and Hospitals letterhead (Rev. 9/07). If no record is found, the fees are kept for the search.
- Typical processing
- Not provided
- Form revision
- Rev. (9/07)
- Source
- Official government page