Michigan Senior Birth Certificate Application (DCH-0569-BX-SR)
Official state formOther copy requestsForm DCH-0569-BX-SRFree downloadLast verified November 10, 2026
Application for a certified copy of your own Michigan birth record at the reduced senior fee for people age 65 or older. It is mailed with payment and ID to the MDHHS Vital Records office in Lansing.
Who can use this form
- You must be age 65 or older and requesting your own birth record.
- The reduced fee does not apply to heir or guardian requests.
- Anyone else must use the regular birth record application.
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.
- A copy of the court order if you had a court-ordered legal name change.
- A check or money order made out to the "State of Michigan".
- For rush service, add the rush fee and address the envelope to "Vital Records RUSH" at the same P.O. box.
Where to send it
- Mail to
- Vital Records Requests P.O. Box 30721 Lansing MI 48909
- State fee
- $14 senior fee (includes one certified copy or a no-find letter); $12 per additional year searched; $16 per additional certified copy; $12 extra for rush processing.
- Typical processing
- Regular: about 4 to 6 weeks of in-office processing, then regular mail. Rush: about 2 to 3 weeks of in-office processing, then regular mail.
- Form revision
- Rev. 4-23
- Source
- Official government page