Fillable Printable Birth Certificate Request - Oklahoma

Birth Certificate Request - Oklahoma

Full Nam e AT BIRTH:

(IF THE BIRTH NAME WAS LEGALLY CHANGED, please see instruction on back)  Male  Female

____________________ ___________________________ ___________________________

First Middle Last

Date of Birth: _____ / ______ / _____ Place of Birth: _____________________ , OKLAHOMA

Month Da y Year City and/or County

Full Name of Father: _______ _____________ ___________ _____________ _______________________

First Middle Last

Full MAIDEN Name of Mother: __________ _______ ________________ ________________________________

First Middle Last Name prior to first marriage

This request is being made by:

(See elig ib ility instructions on the back o f this form)

 Subject of the record  Parent  Legal Guardian or Custodian  Authorized Agent, must specify: ______________ ____________________

Current Address (REQUIRED):

Name ___________________________________________________________ Daytime Telephone Number: (________) _______ - ________________

Mailing Address _______________________________________________Apt _______ City, State and Zip _____________________ _________

E-mail Address_______________________________________________________________  No email

Purpose for which the birth certificate is needed:

 Drivers License

 Social Security

 Passport  School  State Assistance Pgm  Other, specify: _____________________ ___________________

By signing below, I declare that all information provided on this request is true and correc t.

Signature: ______________________________________ ____________________ Date Signed: _________________________________

(Request will not be pro cessed without the signature an d ID of the applicant, full fees, and established eligibility.)

If Child less than 2 yrs:

__________________

Name of Hospital or Mid wife

Division of Vital Records

Phone: 1000 NE 10

Street PO Box 53551 Walk-in Hours:

(405) 271-40 40 Oklahoma City, OK 73117 Oklahoma City, OK 73152 Mon-Fri 8:30-4:00

Birth Certificate Request

Fees

A fee is to be paid for a search of the files or records, even when no copy is available. Search fees are non-transferable and non-refundable.

_______ Number of certified copies requested ($15 each and includes search fee)

_______ Delayed registration, amendment, paternity, adoption, or legitimation fee ($40 - Includes one certified copy)

_______ Number of Heirloom certificates requested: ($35 each and includes one certified copy)

_______ Total Amount enclosed Make checks payable to OSDH. Do n ot send cash by mail.

OFFICE USE ONLY

Mail Front Desk

Reviewed by: ____________________ Date: ______ / _____ / ______ Clerk: ______________ Date: ________ / _______ / ________

Fees Enclosed: $_________________ Fees Due: $ _______________ Fees Paid: $ _______________

Check

Cash

ID Enclosed: _____________________

Requirements:

1) This request must be completed in full.

2) Enclose a copy of a current legal photo ID (SEE BACK FOR LIST OF ACCEPTABLE IDS)

3) Enclose appropriate fees

4) Applicant must sign this form

5) If submitting by mail, enclose a self-addressed stamped env elope

NON-REFUNDABLE FEES: A record search is $15 and includes the issuance of one certified copy if the record is found; additional copies are $15 each.

If no record is found; the fee will not be refunded. The fee to amend a record is $40 ($25 processing fee + $15 for one certified copy). Should you receive a

request for more information, please respond promptly as all fees and files will expire one year after the date paid.

Birth Certificate Request Instruction Sheet

ELIGIBILITY

By state law, birth records filed with this office are not open for p ublic inspection. The person requesting a b i rth certificate must

meet one of the following eligibility standards:

 Be the subject of the record

 Acting in such person’s best interest (an d authorize d by the subject of the record)

 Court order

Effective Nov 1, 2014, records of births occurring at least 125 years ago are ope n record and do not require proof of eligibility.

By signing the request, you are indicating that you are the subject of the record, a court appointed legal guardian, a custodial

guardian, or an authorized agent working in the best intere st of the subject of record. Additional documentation m ay be required to

demonstrate the su bject’s authorization. When an adoption ha s occurred, the biological family and the adopt ee no longer have the

a legal right to the other’s birth records apart from a court order or direct authorization. For a complete list of eligibility

requirements, go to http://www.ok.gov/health/Birth_and_Death_Certificates/Birth_Certificate_Eligibility/index.html

ACCEPTABLE PHOTO IDENTIFICATION

A photocopy of a valid government issued photo ID by either the applicant or an individual attesting for the appli cant is

required. Note: Send a photoco py. Do not send your original ID. Photocopies must be legible and cannot be expired.

 U.S. Issued Driver’s license or Identification ca rd

 U.S. Passport

 Foreign Issued Passpo rt with Visa (I-94)

 Government issued Milita ry photo ID

 Tribal Photo ID Card containing the bearer’s signature

 Ok Self-Defense Act (S DA) License or Concealed Carry pe rmit

For a complete list, go to http://www.ok.gov/health / Birth_and_Death_Certificates/Acceptable_Identification/index.html

HEIRLOOM BIRTH CE RTIFICATES $ 35.00 and includes one certi fied copy of the original certificate.

The Heirloom Birth Certificate is 8 1/2 x 11" with a chocolate brow n and mint green color palette bearing a depiction of a redbud -

the state tree redbud. The certificate will reflect the child's name, date of birth, gender, place of birth and the names of the parents.

Proceeds from the issuance of Heirloom Birth Certificates are u se d by the Child Abuse Training and Coordination Program to

provide training and technical assi stance to judges, prosecutors and members of the multidisciplinary child abuse teams who

intervene in circumstances of child abuse.

FEES: A record se arch is $15 and includes the issuance of one certified copy if the record is found; additional copies are $15

each. If no record is found; the search fe e will not be refunded. The fee to amend a record is $ 40 ($25 processing fee + $15 for

one certified copy). Should you receive a request for more information, please respond p romptly as all fees and files will expire

one year after the date paid.

IF BOTH PARENTS DO NOT APPEAR ON THE BIRTH CERTIFICATE

If both parents’ name s a re not indicated on the origina l Certificate of Birth, a complete copy of the birth record can only be

obtained by the parent named on the record, the subject of the birth record if of legal age, or a person having legal custody or

guardianship of the subject of the birth record. If the certificate is required for “adoption purposes,” the signature of the attorney of

record and a statement from him/her to that effect is required.

NAME CHANGES

If a change to the name of the subject of the birth record has occu rred as a result of legal action, the person requesting the birth

record must identify in the place marked “full name at birth” the current legally altered name of the subject o f the birth record, and

that name must agree with the information that now appears on the certificate. If a change needs to be made to the record,

complete the request with the informatio n that currently appears on the certificate and attach a letter specifying the chang es.

(Additional Instructions will be mailed once the request has been reviewed.)

SUBJECT OF THE BIRTH RECORD I S DECEASED

If the subject of the original Certificate of Birth is deceased, the birth record will be marked with a notation indicating that the

subject of the record is deceased.

NOT BORN IN OKLA HOMA?

If you were not born in Oklahoma, please visit http://www.cdc.gov/nchs/howto/w2w/w2welcom.htm for a com plete listing of

national vital statistics offices.

QUESTIONS

If you have any questions visit our official website http://www.health.ok.gov/program/vital or call our office at (405) 271-4040.

 Resident Alien Card (Form I-551)

 Employment Authorization Card (Fo rm I-766)

 Employment Authorization Card (Fo rm I-688A)

 Temporary Resident Card (Form I-688)

 Oklahoma Dept of Corrections Consolidated Reco rd Card (CRC)