Fillable Printable Application for a Birth Record - South Dakota

Application for a Birth Record - South Dakota

SEAL

Self

Current Spouse

Parent

Child

Guardian

Certified Certified Photostatic

Informational Informational Photostatic

VITAL RECORDS

Male

Female

207 E MISSOURI AVE, STE 1A

PIERRE SD 57501

605-773-4961

South Dakota Application for a Birth Record

To receive a birth record you must:

Choose an ordering method (see

Ordering Methods

in the instructions).

Choose the type of identification that you need (see

Identification

in the instructions).

Determine what fees apply to your request (see

Fees

in the instructions).

Determine if you meet the eligibility requirements (see

Eligibility

in the instructions).

*NOTE*:

If you want to order more than one type of Vital Record (e.g., a birth and marriage record) you need to complete

Sections 1 and 2 (and Sections 3 or 4 if applicable) on this form and the

Application for Vital Records Addendum.

FOR OFFICE USE ONLY

Section 3

Subscribed to and sworn before me this (date):

Signature of Notary Public:

My commission expires:

MAIL APPLICANTS ONLY

- Applicants who are applying by mail must submit

EITHER

a clear copy of a

government issued photo ID that contains the applicant's signature

submit a notarized application.

Section 4

DESIGNATED AGENTS ONLY -

The individual who is designating an agent to collect their record must

complete this section and have their signature notarized.

I, ________________________________________________________ after being duly sworn upon oath,

do here by authorize __________________________________________________________

to act as my

designated agent to obtain certified copies of vital records.

Signature of person designating an agent:

Subscribed to and sworn before me this (date):

Signature of Notary Public:

My commission expires:

Grandparent, grandchild over 18 or sibling only

Designated Agent (Please complete section 4)

Funeral Director, Attorney or Physician

Personal or Property Right

Record over 100 years

ZIP

Section 1

CUSTOMER'S FULL NAME

STREET ADDRESS (if your mailing address is a PO Box, please include your street address of residence)

CITY STATE PHONE NUMBER

( )

I understand that by signing this application, the information that I provide is accurate to the best of my knowledge.

Customer's Signature: Today's Date:

Section 2

FIRST NAME

# OF COPIES

($15 per copy)

MOTHER'S FIRST NAME MIDDLE NAME

FATHER'S FIRST NAME MIDDLE NAME

MIDDLE NAME

DATE OF BIRTH

LAST NAME

CITY AND/OR COUNTY OF BIRTH

MAIDEN NAME/NAME PRIOR TO FIRST MARRIAGE

LAST NAME

TYPE OF COPY RELATIONSHIP - This area must be completed to receive a certified copy

-See

Eligibility

in the instructions

GENDER

VITAL RECORDS

To receive a birth record you must:

1. Choose an ordering method (see

Ordering Methods

2. Choose the type of identification that you need (see

Identification

3. Determine what fees apply to your request (see

Fees

4. Determine if you meet the eligibility requirements (see

Eligibility

VITAL RECORD APPLICATION INSTRUCTIONS

*NOTE*

: If you are ordering multiple types of vital record (e.g., a birth and marriage record) you need to complete

Sections 1 and 2 (and Sections 3 or 4 if applicable) on this form and the

Application for Vital Records Addendum.

ORDERING METHODS

Vital Records Requests can be made using the following methods:

Internet

orders at www.vitalchek.com with a credit card. An additional fee of $11.50 for expedited processing

applies if you choose this method.

Telephone

orders at (605) 773-4961. An additional fee of $11.50 for expedited processing applies if you

choose this method.

Mail

orders may be sent to

Requests made via mail

must submit

: a completed application form, the appropriate fees and proof of identity

as described below. Please mail requests to the address listed in the upper right portion of the South Dakota

Application for a Birth Record.

In-Person

requests can be processed at any South Dakota county Register of Deeds office or at the State Vital

Records Office. Please be ready to provide proof of your identity as outlined below in the Identification section,

pay the appropriate fees and complete this application form.

IDENTIFICATION

Applicants who are applying by mail must

EITHER

submit a clear copy of a CURRENT government issued photo

ID that contains the applicant's signature

have a notary public notarize their signature on Section 3 of the

application.

No government issued ID

? You must send a clear photocopy of any

two

of the following:

Social Security Card Pay stub (must include your name, social security number

Utility bill with current address and the name and address of the business)

Bank statement with current address Car registration or title with current address

FEES

Payment should be made in the form of a check or money order to :

Certified or informational copy of a Birth Record or a certified or informational notification of

a record searched...............................................................................................................................$15 per record

Expedited processing fee (phone or internet requests only).............................$11.50 in addition to $15 per record

ELIGIBILITY

By state law, vital records are not open for public inspection. Vital records may be issued in the form of a

certified or an informational copy.

Only certain individuals are eligible to obtain a certified copy of a vital

record

(see below to determine if you qualify).

Not qualified to receive a certified copy of a vital record?

Any

person who submits an application and the applicable fee can obtain an informational copy of a vital record.

Certified Copies

The record will be computer generated, issued on security paper with a raised seal and have the

signature of the issuing agent. Individuals eligible for a certified copy are the following:

Self

Current Spouse, Child

Parent, Guardian - If guardian, please submit

documentation of your legal guardianship.

Next of Kin - Grandparents, grandchildren over 18

and siblings only

Attorneys, Physicians or Funeral Directors acting

on behalf of the family

Designated Agent - Someone given the authority by

another individual to obtain a vital record on his or

her behalf must complete Section 4.

Personal or Property Right - A right to the record not

included in the categories above. Please submit

documentation of the right with your application.

Informational Copies

These copies will be issued on plain paper and contain the statement "For Informational Purposes Only. Not

for Legal Proof of Identification." An informational copy will not contain a raised seal or the signature of the

issuing agent.

Photostatic Copies

(Certified or Informational)

This record is a photo copy of the original. These records may be requested if the computer generated copy

does not contain the information needed. Generally, these copies are intended for genealogy purposes.

They can be issued certified for legal purposes or informational.