Fillable Printable vital statistics certificate request - Idaho
Fillable Printable vital statistics certificate request - Idaho
vital statistics certificate request - Idaho
IDAHO VITAL STATISTICS CERTIFICATE REQUEST
IDAHO VITAL RECORDS
▪
P.O. Box 83720 y Boise, ID 83720-0036 ▪ (208) 334-5988 y www.healthandwelfare.idaho.gov
Instructions for completing this form are located on the back of this document. Please read these instructions
carefully. Failure to do so may cause a significant delay in processing your request.
YOUR MAILING ADDRESS INFORMATION (PERSON REQUESTING THE CERTIFICATE)
FULL FIRST NAME FULL MIDDLE NAME FULL LAST NAME
STREET AND NUMBER (P.O. BOX) CITY STATE, ZIP CODE
CONTACT PHONE NUMBER (DAY TIME) YOUR RELATIONSHIP TO PERSON NAMED ON CERTIFICATE (SELF, MOTHER, ETC.)
PURPOSE FOR THE CERTIFICATE
SIGNATURE OF THE PERSON REQUESTING THE CERTIFICATE:
►
REQUESTS MUST INCLUDE A COPY (FRONT AND BACK) OF A CURRENT GOVERNMENT-ISSUED SIGNED PICTURE ID OF THE PERSON REQUESTING THE
CERTIFICATE.
(SEE INSTRUCTIONS ON THE BACK OF THIS DOCUMENT)
IMPORTANT: BIRTH, DEATH, STILLBIRTH, MARRIA E OR DIVORCE MUST HAVE OCCURRED IN G IDAHO.
5
INDICATE CERTIFICATE REQUESTED:
BIRTH
STILLBIRTH
Available from July 1911
NAME ON CERTIFICATE:
FULL FIRST NAME FULL MIDDLE NAME FULL LAST NAME
DATE OF BIRTH CITY OF BIRTH NUMBER OF COPIES YOU ARE REQUESTING
FATHER’S NAME:
FULL FIRST NAME FULL MIDDLE NAME FULL LAST NAME
MOTHER’S MAIDEN NAME:
FULL FIRST NAME FULL MIDDLE NAME
FULL LAST MAIDEN NAME
DEATH Available from July 1911
NAME ON CERTIFICATE:
FULL FIRST NAME FULL MIDDLE NAME FULL LAST NAME
DATE OF DEATH CITY OF DEATH NUMBER OF COPIES YOU ARE REQUESTING
5
INDICATE CERTIFCATE REQUESTED:
MARRIAGE DIVORCE
Available from May 1947
HUSBAND’S NAME:
FULL FIRST NAME FULL MIDDLE NAME FULL LAST NAME
WIFE’S NAME:
FULL FIRST NAME FULL MIDDLE NAME FULL LAST NAME (at time of event)
DATE OF EVENT CITY OF EVENT NUMBER OF COPIES YOU ARE REQUESTING
# of copies FEES* $ cost
BIRTH-STILLBIRTH-MARRIAGE-DIVORCE CERTIFIED COPY @ $13.00 EACH
DEATH CERTIFIED COPY @ $14.00 EACH
BIRTH-STILLBIRTH-MARRIAGE-DIVORCE CERTIFIED PHOTOCOPY
@ $13.00 EACH + $5.00 PROCESSING FEE
DEATH CERTIFIED PHOTOCOPY @ $14.00 EACH + $5.00 PROCESSING FEE
SPECIAL HANDLIN
G @ $5.00 (RUSH ORDERS ONLY)♦
PROCESSING FEE FOR LEGAL ACTIONS @ $13.00 EACH
TOTAL ENCLOSED
*
See the back of this document for further instructions,
information, and explanation of fees.
♦
If you would like to RUSH your order, please include a
one-time charge of $5.00 (per order) and write RUSH on
the outside of your envelope. There is no shipping charge
for regular mail. If express mail is desired, you may
express mail your request to us and include a prepaid
express mail envelope back to yourself. We cannot send
your order C.O.D.
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PLEASE READ THESE INSTRUCTIONS CAREFULLY
IDENTIFICATION IS REQUIRED
The applicant (person signing this request) must provide a photocopy of their driver’s license or other current signed government
[state, federal or tribal] issued picture identification. If this is not available, copies of two other forms of identification are required;
one of which MUST include the applicant’s signature. (Refer to the following list) ID is accepted upon validity verification by
our office.
IMPORTANT: If acceptable identification is NOT enclosed, and/or your application is incomplete, your request will be returned
and significant delays in processing your order may occur.
APPROVED IDENTIFICATION LIST
Current
Government
Issued Picture
Identification
with a signature
OR Two Forms of CURRENT ID – One MUST have a Signature OR
•
Driver’s License
•
State ID Card
•
Passport
•
Tribal ID Card
•
Concealed
Weapons
Permit
•
Prison ID Card
•
Social Security Card with signature
•
Work ID Card with picture or signature
•
Auto registration with signature
•
Traffic Ticket with signature
•
Court Record with signature
•
Credit Card with signature
•
College/School ID with picture
•
Check Guarantee Card with signature
•
Matricula Card with signature.
•
Insurance Record
•
Auto Insurance
•
Driver Permit
•
Pay stub
•
Bank Card with signature
•
Doctor/Medical Record
•
Hunting/Fishing License
•
Passport Card
•
Notarized Signature on
the Request
•
Have an immediate
family member (that
has current ID from the
approved list) request it
for you (Please Note:
Proof of relation may
be required.)
•
Court Order
SUBMITTING THE REQUEST
Complete the request form and mail it to the address on the front of the form. Remember to sign your request and
enclose the correct fees and a copy of both sides of your signed picture ID.
FEES
Each certified copy of a Birth, Stillbirth, Marriage or Divorce Certificate is $13.00. Each certified copy of a Death Certificate is
$14.00. Certified copies are computer-generated and are valid for most legal purposes. If the requested certificate cannot be
found, a $13.00 fee will be used for a search, and a statement of search will be issued. A certified photocopy (not computer-
generated) of a Birth, Stillbirth, Marriage or Divorce certificate can be ordered for $18.00; each additional certified photocopy of
that record, ordered at the same time, is $13.00. A certified photocopy (not computer-generated) of a Death Certificate can be
ordered for $19.00; each additional certified photocopy of that record, ordered at the same time, is $14.00. Pursuant to 2010
legislation, a fee of $1.00 has been added to each death certificate to pay for county coroner education.
The Processing fee to complete an adoption, paternity, delayed registration or court order name change is $13.00. (Does not
include a copy of the certificate)
Make checks or money orders payable to Idaho Vital Records.
If you would like to RUSH your order, please include a one-time charge of $5.00 (per order) and write RUSH on the outside of
your envelope. There is no shipping charge for regular mail. If express mail is desired, you may express mail your request to us
and include a prepaid express mail envelope back to yourself. We cannot send your order C.O.D.
To order by fax or on-line, through VitalChek, please see our website at http://www.healthandwelfare.idaho.gov/ or fax your
request to (866) 559-9629. Additional charges will apply. All credit card orders are processed through Vitalchek.
WHO CAN ORDER
O
nly immediate family members, their legal representative, or those who provide documentation showing it is needed for their
property right may order legally confidential certificates. Immediate family includes: spouse, sibling, parent, child, grandparent,
and grandchild.
Proof of relation/legal representation may be required. Step-relatives, in-laws, great-grandparents, aunts, uncles, cousins, etc.
are not immediate family as defined by Idaho Statute.
WARNING: False application for a certified copy of a vital record is a felony punishable by a fine up to
$5,000, five years in prison, or both (Title 39, Chapter 2, Idaho Code).
Rev. 07/2010
