Fillable Printable Birth / Death Certificate Mail Order Form - Washington
Fillable Printable Birth / Death Certificate Mail Order Form - Washington
Birth / Death Certificate Mail Order Form - Washington
Washington State Department of Health
Birth / Death Certificate Mail Order Form
Complete payment and mailing information below:
Total number of certified certificates:
x $20.00 =
$
Total number of Heirloom
+
birth certificates:
x $40.00 =
$
Fee for filing a Paternity Acknowledgment OR an Adoption
$15.00 =
$
Paternity Verification Letter (copy of parent ID required)
$15.00 =
$
Paternity Verification Letter ($15) + certified birth certificate ($20)
$35.00 =
$
First Class Mail (allow 2-3 weeks for delivery)
No additional charge
*USPS Express Mail Delivery (street address or PO Box)
$18.30 =
$
*Fed Ex to continental US (no PO Box)
$15.00 =
$
*Fed Ex to AK/HI/Canada/Mexico (no PO Box)
$25.00 =
$
TOTAL AMOUNT DUE
$
Instructions
• Print clearly.
• We issue certificates for births and deaths that occurred in Washington State only.
• For a birth or death before July 1, 1907, contact the local health department where the event occurred.
• We only accept checks or money orders for mail orders. Do not send cash or credit card information.
• $20.00 per certificate.
• If adopted, provide your adoptive name and adoptive parents’ information.
• Visit www.doh.wa.gov
for more information and ordering options or call 360-236-4300, Monday through Friday
between 8:00 a.m. and 5:00 p.m. Pacific Time.
Contact
Information
Name of person ordering certificate(s):
Company name (if applicable):
Address sending certificate(s) to:
(Street address required for FedEx orders)
City: State: ZIP Code:
Daytime Phone: (______) ______________________ Email Address:
Complete ALL fields below with exact and complete information.
Paternity Verification Letter (Copy of Parent
ID required). Court activities such as custody,
parenting
plan or child support may require a paternity
verification letter AND a birth certificate.
Birth Certificate Request
Number of Certificates Ordering_____
Full Name on Certificate:
(First) (Full Middle Name) (Last)
Date of Birth (Month/Day/Year):
(7/1/1907 – present)
City or County of Birth:
Father/Parent Birth Name:
(First) (Full Middle Name) (Birth/Maiden Last Name)
Not
Listed
Mother/Parent Birth Name:
(First) (Full Middle Name) (Birth/Maiden Last Name)
Death Certificate Request
Number of Certificates Ordering______
Name on Certificate:
(First) (Middle) (Last)
Approximate Date of Death or 10 year
search range (7/1/1907 – present):
Date of Birth, if known:
City or County of Death: Spouse, if known:
Make checks or
money orders payable
to DOH.
MAIL ORDERS TO:
Department of Health
PO Box 9709
Olympia WA
98507-9709
*Additional charges for express delivery are per order, not per certificate.
*Signature is required at time of delivery for USPS Express Mail and Federal Express orders.
DOH 422-044 November 2014 +Go to our website at www.doh.wa.gov for information on Heirloom Birth Certificates.
