Michigan Heirloom Birth Certificate Application (DCH-0569-BX-HEIR)
Official state formCommemorative certificatesForm DCH-0569-BX-HEIRFree downloadLast verified November 10, 2026
Application for a non-certified heirloom copy of a Michigan birth record, or a gift certificate for one. It is not legal proof of birth. It is mailed with payment and ID to the MDHHS Vital Records office in Lansing.
Who can use this form
- The person named on the birth record.
- A parent of the person named on the record (if adopted, only the adoptive parents).
- A legal guardian, custodial party, or holder of a power of attorney, with a copy of the court order or legal documents.
- A licensed attorney for an eligible person, with a letter of representation and ID for both attorney and client.
- An heir of a deceased person named on the record, or anyone if the record is at least 100 years old.
What to send with it
- The completed application, signed by hand in ink.
- A photocopy of valid identification, such as a driver's license, state ID card, passport, or military ID. Originals are not returned.
- Your choice of heirloom style (options 1 to 5) or a gift certificate (option 6) with the recipient's name.
- A copy of the court order if there was a court-ordered legal name change.
- A check or money order made out to the "State of Michigan".
Where to send it
- Mail to
- Vital Records Requests P.O. Box 30721 Lansing MI 48909
- State fee
- $40 base fee (non-refundable, includes one non-certified heirloom copy or one gift certificate); $40 per additional copy. The form says $20 of each purchase goes to the Michigan Children's Trust Fund.
- Typical processing
- About 4 to 6 weeks of in-office processing, then regular mail.
- Form revision
- Rev. 5-23
- Source
- Official government page