Montana Application for Certificate of Nonviable Birth
Official state formStillbirth and pregnancy lossFree downloadLast verified November 10, 2026
A parent uses this form to ask the Montana Office of Vital Records for a commemorative Certificate of Nonviable Birth after an unintentional loss that occurred after a heartbeat was detected but before 20 weeks of gestation.
Who can use this form
- Only the parent or parents of a nonviable birth
- The request must be made within 60 days of the nonviable birth
- The pregnancy must have been verified by a health care provider
- The certificate is a private commemorative document and is not proof of a live birth
What to send with it
- The completed and signed application
- A photocopy of the parent's government-issued photo ID, such as a current driver's license
Where to send it
- Mail to
- Montana Office of Vital Records 111 N Sanders, Rm 6 PO Box 4210 Helena, MT 59604
- State fee
- Not provided
- Typical processing
- Not provided
- Form revision
- Version 1.0
- Source
- Official government page