Birth information of the person on record

Please enter the birth information of the individual who needs the birth certificate. If you are applying for someone else (i.e. your child), enter their birth information here.

1.1 First name at birth

1.2 Middle name at birth

1.3 Last name at birth

Suffix

1.4 Gender

Male

Female

1.5 Has the person on record ever changed his/her name through a marriage?

Yes

1.6 Has the person on record ever changed his/her name by court order?

Yes

2.1 Date of birth

2.2 State of birth

2.3 County of birth

2.4 City of birth

Information about the parents of the person on record

3.1 Mother's first name

3.2 Mother's middle name

3.3 Mother's last name before any marriage (maiden name)

3.4 Mother's last name after marriage if different

4.1 Father's first name

4.2 Father's middle name

4.3 Father's last name

Suffix

4.5 Father unknown or not listed on the birth certificate

Yes

Your name and contact information

Whether you are seeking to apply for your birth certificate or are submitting an application for another person (i.e. your child or spouse), please enter your name and contact information here.

5.1 First name

5.2 Middle name

5.3 Last name

5.4 Email address

5.5 Confirm email address

5.6 Phone number

Relationship to the person on record

6. What is your relationship with the person on the certificate?

7. Why are you applying for a birth certificate?

Address where you would like the birth certificate to be delivered

8.1 Street

8.2 Apt, suite, floor, etc.

8.3 City

8.4 State

8.5 Zip code

Agreement and Privacy Policy

By checking this box, I agree to submit the information provided to this website, and I authorize Vital Records Online to use my information to fill all necessary documents in order to prepare my application materials. I understand that VitalRecordsOnline.com is a private document preparation service and that I am hiring them to prepare my birth certificate application materials. I understand there is a service fee charged by VitalRecordsOnline.com and I will pay the health department required fee directly by check or money order. I understand I may have to provide additional documents to the health department in order to prove my identity. By submitting the form above, I agree to these terms and the terms of this website.