Fillable Printable Application for a Copy of a Birth Certificate - North Carolina
Fillable Printable Application for a Copy of a Birth Certificate - North Carolina
Application for a Copy of a Birth Certificate - North Carolina
DHHS-VR-B (Revised 05/2015)
N.C. Vital Records (Review 05/2018)
North Carolina Department of Health and Human Services
Division of Public Health • N.C. Vital Records
http://vitalrecords.nc.gov
Telephone: 919-733-3000
Mail: 1903 Mail Service Center Location: 225 North McDowell St.
Raleigh, NC 27699-1903 Raleigh, NC 27603-1382
PLEASE PRINT
Application for a Copy of a North Carolina Birth Certifi cate
Certifi cate Information
Full Name on Certifi cate
(If adopted, provide new information)
_________________________________________________________________
First Name Middle Name Last Name
Date of Birth ____ | ____ | ________
Month Day Year
Sex Male Female
Were parents married at time of
birth? Yes No
Is this person deceased? Yes No
Place of Birth _________________________________________
City County
Full Name of Parent
(Adoptive parent, if applies)
____________________________________________________________________
First Name Middle Name Last Name Last Name (before any marriage, if different)
Full Name of Parent
(Adoptive parent, if applies)
____________________________________________________________________
First Name Middle Name Last Name Last Name (before any marriage, if different)
Check all boxes that apply; add the fees in 1–3
and place the total amount in #4.
See further instructions on Page 2.
Your Relationship to the Person Whose Certifi cate is Requested:
(Check one)
1. Order Certifi cate
Processing times vary.
Check website for current information.
(Non-refundable fee)
Certifi cate Search and First Copy ($24) $_______
#___ additional copies x $15 $_______
Certifi ed (Legally suitable for any purpose)
Uncertifi ed (Suitable for research purposes)
Self
Spouse (Current)
Brother/Sister
Child
Parent/Step-Parent
Authorized agent, attorney or legal representative
of the person listed (Proof REQUIRED)
Other (may not be entitled to a certifi ed copy)
(Please Print)
Requestor: ____________________________________________________________
Print Name of Person Requesting a Certifi cate
Address: ____________________________________________________________
Street Address (P.O. Box cannot be used for expedited shipping)
_______________________________________________________________________
P.O. Box (If mailing to a P.O. Box, street address must also be listed above)
_______________________________________________________________________
City, State, Zip Code
_______________________________________________________________________
(Area Code) Telephone Number (During business hours)
Email Address: _________________________________________________________
Payment: Please pay with a cashier’s check or money order made payable to N.C. Vital
Records. Personal checks are not accepted. Requests that are submitted with no payment,
or incomplete payment or incomplete information will be returned. Credit card payment
is available for walk-in customers.
ID OF THE PERSON REQUESTING A CERTIFICATE IS REQUIRED:
See Page 2 for a list of acceptable IDs. Requests that do not include proper identifi cation
will be returned.
2. Record Changes (Only if applies)
Appointment required for in-person services.
($15 non-refundable processing fee)
Adoption $_______
Amendment $_______
Name Change $_______
Legitimation Court Order $_______
Legitimation (mother married father
after child’s birth) $_______
Paternity (no fee) $ 00.00
Other _____________________ $_______
3. Faster Service (Choose only one)
Optional for mail-in requests
($15 non-refundable expedite fee)
Walk-in Service ($15) $_______
Expedited Processing ($15) $_______
(Shipped by regular mail)
Expedited Processing and
Expedited Shipping ($35) $_______
(Call for expedited shipping fees outside the continental United States)
4. Total Fees
(Add 1+2+3 above for total) $_______
I hereby certify that all the above information is true to the best of my knowledge. Note: It is a felony violation of N.C. Law (G.S. 130A-26A)
to make a false statement on this application or to unlawfully obtain a copy or a certifi ed copy of a birth certifi cate.
___________________________________________________________ _________________________________________
Signature of Person Requesting a Certifi cate Date
Offi ce Use Only: SFN _______________________________ DCN _____________________________ Cartridge/Frame _________________________________
Amount received: $_______________________ Identifi cation presented_________________________________________________________________________
Request number ___________________________________________ Request date _______________________________________________________________
Grandparent
Specify
How do you plan to use this record?
DHHS-VR-B (Revised 05/2015)
N.C. Vital Records (Review 05/2018)
Order Certifi cate
A certifi cate search costs $24 and includes one copy if the certifi cate is located. The search covers a three year
period. Requests are processed in the order received and can take up to fi ve weeks plus the mail delivery time.
The search fee is required to process a request and is non-refundable even if a record cannot be located.
Record Changes
Complete this section only if you are making a request to change information on the birth certifi cate. The $15
processing fee to review your request is non-refundable. In-person assistance for this service is by appointment
only. Please call (919) 792-5986 to schedule an appointment. If your request involves more than one birth
record, the $15 processing fee applies to each individual’s birth record that requires change(s).
Faster Service
To receive expedited service you MUST write “Expedite” on the outside of the envelope. Expedited requests
will be processed within 10 business days. This does not include the additional day(s) for shipping. This is a
non-refundable fee.
Identifi cation Requirement
Due to identity theft and other fraudulent use of vital records, ID of the person requesting a certifi cate is
REQUIRED. Requests that do not include ID will be returned. You MUST include a legible photocopy of
one of the photo IDs listed below with your request:
Current state-issued driver’s license (address must match requestor’s address on application)
Current state-issued non-driver photo ID card (address must match requestor’s address on application)
Current Passport or Visa (must include photo)
Current U.S. military ID
Current Department of Corrections photo ID card dated within the last year
Current state or U.S. government agency photo ID card (for persons requesting certifi cates as part of that
agency’s business)
Current student ID card with copy of transcript
If you do not have one of the IDs listed above, you must provide legible photocopies of TWO of the following
(must be two DIFFERENT forms of ID):
Temporary driver’s license
Current utility bill with current address
Car registration or title with current address
Bank statement with current address
Pay stub with current address
Income tax return/W-2 form showing current address
Letter from government agency dated within the last six months and showing current address
State-issued concealed weapon permit showing current address
If you are unable to meet our ID requirements, a family member or other person
who is entitled to obtain the certifi cate, and who can meet the ID requirements, may request it.
A list of persons entitled to obtain certifi cates is located on our website at
http://vitalrecords.nc.gov/faqs.htm.
