Free Printable Birth Certificate Template - Free Download
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Free Printable Birth Certificate Template
Free Printable Birth Certificate Template
Doc. No. 35-05-20/09/08/02
OFFICE OF VITAL STATISTICS
JESSE S. COOPER BLDG.
417 FEDERAL STREET
DOVER , DE 19901
(302) 744-4549
CHOPIN BUILDING
258 CHAPMAN RD.
NEWARK, DE 19702
(302) 283-7130
THURMAN ADAMS STATE SERV CTR.
546 S. BEDFORD ST.
GEORGETOWN, DE 19947
(302) 856-5495
CREDIT CARD ORDERS VIA THE INTERNET: www.vitalchek.com
APPLICATION FOR A CERTIFIED COPY OF A DELAWARE BIRTH CERTIFICATE
PLEASE COMPLETE ALL ITEMS REQUESTED BELOW AS ACCURATELY AS POSSIBLE.
Name on Birth Certificate
Middle Name
Last Name at Birth
Sex Male Female Date of Birth (mm/dd/yyyy)
Place of Birth
City
State
Hospital if Known
Name of Mother or
Name of Parent A
Middle Name
Last Name at Birth
Name of Father or
Name of Parent B
First Name
Middle Name
Last Name at Birth
RELATIONSHIP TO THE PERSON WHOSE BIRTH CERTIFICATE YOU ARE REQUESTING (PLEASE CHECK ONE BOX)
Myself
My current husband or wife*
My child
My parent*
I am the legal guardian (court order required)
I am the authorized agent, attorney or legal representative
of the person listed in 1-5 (proof required)
*Proof of relationship (eg. marriage or birth certificate)
Number of copies requested:
REQUIRED UPON FILING OF APPLICATION
1. Cost: $25.00 per copy (If record is not located, fee will be retained for search). Make checks or money orders payable
to the
Office of Vital Statistics
.
2. Copy of your official valid photo identification (Drivers license, State ID or Work ID)
3.
Parents identification needed for children
PERSON APPLYING FOR CERTIFICATE
I hereby certify that all the above information is true to the best of my knowledge. It is a felony violation of Delaware Law
(16 Del. C.§3111) to make a false statement on this application or to unlawfully obtain a certified copy of a birth certificate.
Print name of person applying for certificate
Signature of person applying for certificate
Date
Street Address
City/Town
State
Zipcode
Daytime Phone
FOR OFFICE OF VITAL STATISTICS USE ONLY
Identification:
Free Printable Birth Certificate Template Previous Page
source: delaware.gov
Free Printable Birth Certificate Template
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