Nebraska Application for Certificate of Birth Resulting in Stillbirth (HHS-89)
Official state formStillbirth and pregnancy lossForm HHS-89Free downloadLast verified November 10, 2026
Mail-in request for a certified Certificate of Birth Resulting in Stillbirth. It goes to the Nebraska Vital Records office.
Who can use this form
- Only the parent or parents of the stillborn child (fetal death)
What to send with it
- Signed application
- Photocopy of a photo ID
- Exact fee payable to Vital Records
- Stamped self-addressed business-size envelope
Where to send it
- Mail to
- Vital Records PO Box 95065 Lincoln, NE 68509-5065
- State fee
- $17.00 per certified copy
- Typical processing
- Not provided
- Form revision
- 6/21
- Source
- Official government page