Michigan Stillbirth Record Application (DCH-0569-SB)
Official state formStillbirth and pregnancy lossForm DCH-0569-SBFree downloadLast verified November 10, 2026
Application for a certified copy of a Michigan stillbirth record. It is mailed with ID, and payment when a fee applies, to the MDHHS Vital Records office in Lansing.
Who can use this form
- A parent of the child named on the record.
- A licensed attorney representing a parent, with a letter of representation and ID for both attorney and client.
- An heir of the deceased.
- A court of competent jurisdiction, with a court order and fee.
What to send with it
- The completed application, signed by hand in ink.
- A photocopy of valid identification, such as a driver's license, state ID card, passport, or military ID. Originals are not returned.
- The child's name, date and place of delivery, and the parents' names and dates of birth.
- If a fee applies, a check or money order made out to the "State of Michigan".
- For rush service, add the rush fee and address the envelope to "Vital Records RUSH" at the same P.O. box.
Where to send it
- Mail to
- Vital Records Requests P.O. Box 30721 Lansing MI 48909
- State fee
- Two no-fee copies are available over the life of each stillbirth record. After those are claimed: $34 for the first paid copy; $16 per additional certified copy; $12 per additional year searched; $12 extra for rush processing.
- Typical processing
- Regular: about 4 to 6 weeks of in-office processing, then regular mail. Rush: about 2 to 3 weeks of in-office processing, then regular mail.
- Form revision
- Rev. 4-23
- Source
- Official government page