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NEW, AS OF OCT. 1, 2006.
You must have a picture ID or two other forms of identification. One MUST have a signature
http://www.dphhs.m.gov/statisticalinformation/vitalrecordsstatistics.shtml.
Check for appropriate approved identifications to save time.
This is the pdf. I have copied the FRONT of the form right here so you can see it. Be SURE to get the original from Helena.
http://vhsp.dphhs.mt.gov/certificates/birthappfillable.pdf
This is the actual form in this pdf link above.
_______________________________________________________
MONTANA VITAL STATISTICS
111 N SANDERS RM 209 / PO BOX 4210
HELENA, MONTANA 59604-4210
406-444-2685
PLEASE READ THESE INSTRUCTIONS CAREFULLY
WHO CAN ORDER A BIRTH CERTIFICATE?
Only those authorized by 50-15-121 MCA, which includes the registrant (14 years old or older), the registrant’s spouse, children, parents, or guardian, or an authorized
representative, or those who provide documentation showing it is needed for determination or protection of the individuals personal or property rights, proof of relationship,
guardianship, or authorization is required may obtain certify copy of a birth record.
Step-relatives, in-laws, grandparents, aunts, uncles, cousins, ex-spouses, and a natural parent of an adoptive child are not eligible to receive a certified copy of a birth
certificate.
IDENTIFICATION IS REQUIRED
The person signing the request must provide an enlarged legible photocopy of both sides of their valid driver’s license or other legal picture identification with a signature or
the requestor must have this application notarized.
*******SEE THE BACK OF THIS APPLICATION FOR A LIST OF ACCEPTABLE IDENTIFICATION*****get the real form***
IMPORTANT: If the identification requirement is NOT met or if the application is incomplete, your request will be returned and
significant delays in processing your order may occur.
FEE (All fees must be U.S. funds)
CERTIFIED COPIES OF A BIRTH CERTIFICATE cost $12.00 for the first copy, $5.00 for each additional copy of the same record. (non-refundable)
INFORMATIONAL COPIES OF A BIRTH CERTIFICATE may be issued to anyone as long as the birth occurred 30 years prior to the date of application, the cost
is $10.00. (non-refundable)
CERTIFIED COPIES OF DOCUMENTS on file with the state (i.e. Acknowledgment of Paternity, correction affidavits), the cost is $12.00 (non-refundable)
SEARCHES: $10.00 for the first 5 years searched, then $1.00 per year over the first five years per name requested. (An informational copy will be issued if record is
found) (non-refundable)
SHIPPING credit card orders only)
After October 1, 2006
$10.50 shipping and handling fee (for fax or credit card orders only)
$18.00 for Express Courier weekday delivery in the continental United States. (for
fax or credit card orders only)
$25.00 for Express Courier weekday delivery to Alaska and Hawaii. (for fax or
credit card orders only)
Method of Delivery: Regular Mail Express Courier (cannot be delivered to a PO BOX) (package must be signed for)
Credit Card # ________________________________________________________ ___________________ Expiration Date _____________________
Please complete the following information.
FULL First, Middle and Last Name on Birth Certificate:_______________________________________________ ______________________________
Has name ever been changed other than marriage _____ No _____ Yes if so original name _________________________________________________
Date of Birth: Place of Birth (City or County):__________________________________________
Mother’s Full Maiden Name: __________________________________________________
Father’s Full Name:__________________________________________________ _________ # of copies needed
Your relationship to the certificate holder :__________________( self, mother, father etc) Reason the Birth Certificate is needed: _________________
Mailing or Delivery Address:
Name: ___________________________________________________Applic ant’s Signature______________________________
Address: ________________________________________________________ _________________________________________
City, State, Zip: _________________________________________________ Daytime Telephone Number: __________________
_____________________________________ ___Notary_ (For use if needed)________________________________________
_______________________________ personally appeared before me and whose
identity I proved on the basis of satisfactory evidence to be the signer of the above
instrument.
Subscribed and sworn to before me this__________ day of _______________ 20____
Signature: ____________________________________
Printed Name: __________________________________
SEAL Notary Public in and for the State of _________________
Residing at _________My commission Expires_________
NOTICE: STATE LAW PROVIDES PENALTIES FOR PERSONS WHO WILLFULLY AND KNOWINGLY USE OR
ATTEMPT TO USE THIS CERTIFICATE FOR ANY PURPOSE OF DECEPTION. (50-15-114, MCA)
Official Use Only
Date ____________________________________
Rec# ___________________________________
Amount _________________________________
Cert #___________________________________
Ser #____________________________________
Comment _______________________________
________________________________________
http://vhsp.dphhs.mt.gov/certificates/ordercertificates.shtml Link for the PDF
The following contacts may be used to assist you:
For general questions on how to obtain a birth or death certificate, and individual marriage and divorce information, please contact:
Montana Dept of Public Health and Human Services
Office of Vital Statistics at (406) 444-2685 or (406) 444-4252
or E-mail us at
HHSVitalRecords@mt.gov (Note: Applications are not accepted via E-mail.)
Page last updated: 09/11/2006
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