docs.templates.birth-certificate-us.name

[Applicant Name]

[Applicant Address]

19.10.2026

Vital Records Office

[County] County

State of [State]

RE: Application for Certified Copy of Birth Certificate

To the Registrar of Vital Records:

I, [Applicant Name], hereby apply for a certified copy of the birth certificate described below, pursuant to the vital records laws of the State of [State].

REGISTRANT INFORMATION

Full Name on Record: [Registrant Full Name]

Date of Birth: [MM/DD/YYYY]

Parents' Names (as listed on record): [Parent 1 Full Name / Parent 2 Full Name]

APPLICANT ELIGIBILITY

Relationship to Registrant: [e.g. Self / Parent / Child / Legal Guardian / Spouse]

PURPOSE OF REQUEST

[Purpose, e.g. 'Obtain passport', 'Replace lost certificate', 'Enroll in school']

DECLARATION

I declare under penalty of perjury under the laws of the State of [State] that I am an authorized requester of this vital record and that the information provided above is true and correct to the best of my knowledge. I understand that unauthorized procurement of a vital record is a violation of state law and may be punishable as a criminal offense.

Enclosed: copy of my government-issued photo identification and applicable fee.

NOTE: This is a template for guidance only. Laws vary by state. Seek legal advice for your specific situation. Eligibility, fees, and required identification differ by jurisdiction. Submit to the vital records office of the state or county where the birth occurred.