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 =
$
Feefor 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 issuecertificates for births and deaths that occurred in Washington Stateonly.
•Fora birth or death before July 1, 1907,contact the localhealth departmentwhere the event occurred.
•We only accept checksor money ordersfor 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, Mondaythrough Friday
between8:00 a.m. and5:00p.m.Pacific Time.
Contact
Information
Name of person orderingcertificate(s):
Companyname (if applicable):
Address sendingcertificate(s)to:
(Street address required for FedEx orders)
City:State:ZIP Code:
Daytime Phone: (______) ______________________Email Address:
Complete ALL fields below withexactand completeinformation.
Paternity Verification Letter(Copy of Parent
ID required).Court activitiessuch as custody,
parenting
plan or child support mayrequireapaternity
verification letter AND a birth certificate.
Birth Certificate Request
Number of Certificates Ordering_____
Full Name on Certificate:
(First) (FullMiddleName)(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/MaidenLast Name)
Not
Listed
Mother/Parent Birth Name:
(First) (Full Middle Name)(Birth/MaidenLast 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:
Departmentof 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 USPSExpress Mail and Federal Express orders.
DOH 422-044 November 2014+Go to our website at www.doh.wa.govfor informationon Heirloom Birth Certificates.
