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South Dakota · Birth

South Dakota Application for a Certificate of Birth Resulting in Stillbirth

Official state formStillbirth and pregnancy lossFree downloadLast verified November 10, 2026

Application for a parent to request a Certificate of Birth Resulting in Stillbirth. Mail it with a $10 check or money order to the Office of Vital Records.

Who can use this form

  • Only the mother or father listed on the record

What to send with it

  • Completed form
  • A photocopy of your government photo ID in Box A, or have the form notarized in Box B
  • Check or money order for $10 payable to Vital Records
  • Optional: the name you wish to give your stillborn child

Where to send it

Mail to
VITAL RECORDS 221 W Capitol Ave Pierre SD 57501
State fee
$10
Typical processing
3-5 business days by mail (office web page)
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South Dakota Application for a Certificate of Birth Resulting in Stillbirth | South Dakota Form