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Fillable Printable Application for a Certified Copy of a Birth Certificate - Delaware
Fillable Printable Application for a Certified Copy of a Birth Certificate - Delaware
Application for a Certified Copy of a Birth Certificate - Delaware
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
APPLICATION FOR A CERTIFIED COPY OF A DELAWARE BIRTH CERTIFICATE
PLEASE COMPLETE ALL ITEMS REQUESTED BELOW AS ACCURATELY AS POSSIBLE.
Name on Birth Certificate
First Name 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
First Name 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.
Parent’s 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:
