District of Columbia Request for Commemorative Stillbirth Certificate
Official state formCommemorative certificatesFree downloadLast verified November 10, 2026
Use this form to request a commemorative stillbirth certificate, including for an early loss under 20 weeks and 350 grams. Start dates for early-loss records differ between the office's page and its instruction sheet.
Who can use this form
- The same people who may request a fetal death certificate
- A parent named on the record, a domestic partner, a sibling or grandparent (with proof), a guardian of the parent, or a legal representative
What to send with it
- Completed request form
- Proof of identity
- Do not send payment until the office approves the request; it then gives payment options
- Records for early loss: the office's page says filed after 8/7/2023; its instruction sheet says filed after 12/31/2018
Where to send it
- Mail to
- Attn: CSCO Unit Vital Records Division District of Columbia Department of Health 2201 Shannon Pl. SE, 1st Floor Washington DC 20020
- State fee
- $50 per certificate (printed on the form)
- Typical processing
- Not provided
- Form revision
- Revised 9/16/2022
- Source
- Official government page