Alaska Commemorative Certificate of Stillbirth Request
Official state formStillbirth and pregnancy lossFree downloadLast verified November 10, 2026
Request for a commemorative certificate of stillbirth from the state vital records office. A parent may give the child's name if none was provided. Send it by mail, fax or in person with payment and a copy of your ID.
Who can use this form
- Parent(s) listed on the certificate
- A parent may give the child's name if none was provided
What to send with it
- Signed form (requests without a signature, ID copy and payment are not processed)
- Photocopy of a government photo ID, not the original (an expired ID must have expired less than one year ago)
- Payment by check or money order to Alaska Vital Records Office, or card details on the form; cash only at walk-in offices
- Optional: the child's name, if none was provided; without a name the certificate shows "Baby Boy" or "Baby Girl"
Where to send it
- Mail to
- Health Analytics and Vital Records P.O. Box 110675 Juneau, Alaska 99811-0675
- State fee
- $30 first copy, $25 each additional copy of the same record (from the form; the office's order page does not list this certificate). Shipping: regular mail free, Priority Mail $13, with signature $18.
- Typical processing
- Not provided
- Form revision
- Revision 04/2026
- Source
- Official government page