Vermont Statement of Information to Appear on Delayed Certificate of Birth
Official state formDelayed registrationFree downloadLast verified November 10, 2026
This companion form gives the child and parent information to print on a delayed Vermont birth certificate. It is notarized and submitted with the delayed birth application to the Vital Records Office.
Who can use this form
- The applicant, either the person born or a parent.
- The form must be notarized.
What to send with it
- The completed, notarized statement.
- Submit it with the Application for Delayed Certificate of Birth.
Where to send it
- Mail to
- Vital Records Office 280 State Drive Waterbury, VT 05671-8370
- State fee
- Not provided
- Typical processing
- Not provided
- Form revision
- February 2024
- Source
- Official government page