Fillable Printable Birth Certificate Request - Oklahoma
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 ParentLegal Guardian or CustodianAuthorized 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:
Passport SchoolState 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 40Oklahoma City, OK 73117 Oklahoma City, OK 73152 Mon-Fri 8:30-4:00
Birth Certificate Request
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, orlegitimation fee ($40 - Includes one certified copy)
_______ Number of Heirloom certificates requested: ($35 each and includes one certified copy)
_______ Total Amount enclosedMake 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: $ _______________
ID Enclosed: _____________________
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
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)
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 //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
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 //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.
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 //www.cdc.gov/nchs/howto/w2w/w2welcom.htm for a com plete listing of
national vital statistics offices.
If you have any questions visit our official website //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)