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Fillable Printable Application for a Birth Record - South Dakota

Fillable Printable Application for a Birth Record - South Dakota

Application for a Birth Record - South Dakota

Application for a Birth Record - South Dakota

SEAL
SEAL
Self
Current Spouse
Parent
Child
Guardian
CertifiedCertified Photostatic
InformationalInformational 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
OR
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
C
U
S
T
O
M
E
R
CUSTOMER'S FULL NAME
STREET ADDRESS (if your mailing address is a PO Box, please include your street address of residence)
CITYSTATEPHONE 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
B
I
R
T
H
R
E
C
O
R
D
FIRST NAME
# OF COPIES
($15 per copy)
MOTHER'S FIRST NAMEMIDDLE NAME
FATHER'S FIRST NAMEMIDDLE 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 COPYRELATIONSHIP - This area must be completed to receive a certified copy
-See
Eligibility
in the instructions
GENDER
VITAL RECORDS
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
OR
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 CardPay stub (must include your name, social security number
Utility bill with current addressand the name and address of the business)
Bank statement with current addressCar 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
forLegal 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.
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