Hawaii Birth certificate application form

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.

FIRST NAME AT BIRTH

MIDDLE NAME AT BIRTH

LAST NAME AT BIRTH

SUFFIX

GENDER

Male

Female

HAS THE PERSON ON RECORD EVER CHANGED HIS/HER NAME THROUGH A MARRIAGE?

Yes

HAS THE PERSON ON RECORD EVER CHANGED HIS/HER NAME BY COURT ORDER?

Yes

DATE OF BIRTH

STATE OF BIRTH

COUNTY OF BIRTH

CITY OF BIRTH

INFORMATION ABOUT THE PARENTS OF THE PERSON ON RECORD

MOTHER'S FIRST NAME

MOTHER'S MIDDLE NAME

MOTHER'S LAST NAME BEFORE ANY MARRIAGE (MAIDEN NAME)

MOTHER'S LAST NAME AFTER MARRIAGE IF DIFFERENT

FATHER UNKNOWN OR NOT LISTED ON THE BIRTH CERTIFICATE

Yes

FATHER'S FIRST NAME

FATHER'S MIDDLE NAME

FATHER'S LAST NAME

FATHER'S SUFFIX

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.

FIRST NAME

MIDDLE NAME

LAST NAME

PHONE NUMBER

EMAIL ADDRESS

CONFIRM EMAIL ADDRESS

RELATIONSHIP TO THE PERSON ON RECORD

WHAT IS YOUR RELATIONSHIP WITH THE PERSON ON THE CERTIFICATE?

WHY ARE YOU APPLYING FOR A BIRTH CERTIFICATE?

ADDRESS WHERE YOU WOULD LIKE THE BIRTH CERTIFICATE TO BE DELIVERED

STREET

APT, SUITE, FLOOR, ETC.

CITY

STATE

ZIP CODE

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.