Pennsylvania Application for a Fetal Death Certificate (HD002180)
Official state formStillbirth and pregnancy lossForm HD002180Free downloadLast verified November 10, 2026
Orders a certified fetal death certificate for a fetal death registered in Pennsylvania. Mail it with identification and payment to the Division of Vital Records in New Castle.
Who can use this form
- The applicant must be 18 or older, or an emancipated minor
- A parent
- A brother, sister, half-brother or half-sister, grandparent or great-grandparent
- A person holding power of attorney, or an attorney or legal representative
- Extended family with a direct relationship
What to send with it
- Completed and signed application
- Photocopy of a valid government-issued photo ID, or two current documents that show your name and address
- Check or money order payable to "VITAL RECORDS"
- For the armed forces fee waiver, for parents only: a copy of the Military ID or DD214
Where to send it
- Mail to
- Department of Health Division of Vital Records PO Box 1528 New Castle, PA 16103
- State fee
- $20.00 per certificate. Waived for a parent who is a member or veteran of the U.S. armed forces.
- Typical processing
- Up to 4 weeks once received at the New Castle office
- Form revision
- REV 01/25
- Source
- Official government page