Minnesota Request for Certificate of Birth Resulting in Stillbirth
Official state formStillbirth and pregnancy lossFree downloadLast verified November 12, 2026
Request by a parent for a Certificate of Birth Resulting in Stillbirth or a Fetal Death Report, issued only for fetal deaths at 20 weeks or more. Mail it, signed before a notary, to the Minnesota Department of Health, Office of Vital Records.
Who can use this form
- Only a parent named on the fetal death record.
- The parent who gave birth may also request the noncertified report with health information.
- Issued only for fetal deaths at 20 weeks or more gestation.
- Not available through county vital records offices.
What to send with it
- The completed form, signed in front of a notary public.
- Payment, not cash.
- The form says the Department of Health shares information with the Department of Revenue for the stillborn tax credit.
Where to send it
- Mail to
- Minnesota Department of Health Office of Vital Records Mail: PO Box 64499, St. Paul, MN 55164-0499 Courier/express delivery: 625 Robert St. N, St. Paul, MN 55155 (no vital-records counter service at this location) Fax: 866-416-1357 (credit card payments only)
- State fee
- $16 for the first Certificate of Birth Resulting in Stillbirth and $9 for each extra one. A noncertified fetal death report is $9, and $9 with health information. Faster processing is $20 and express delivery is $21. As printed on the form.
- Typical processing
- Not provided
- Form revision
- 06/2024
- Source
- Official government page