REQUEST'FOR'CERTIFIED'COPY'OF'A'WYOMING'VITAL'RECORD'
Vital&Statistics&Services&•&2300&Capitol&Avenue&•&Cheyenne,&WY&82002&
WDH_VSS&Application&for&Certified&Copy&Form&1a&–&2024
For&office&use&only:&
For&office&use&only:&
For&office&use&only:&
WYOMING BIRTH RECORD — Record(s) Requested ($25 each): (SEE EXCESSIVE COPIES BELOW)
_____ (#) Birth Certificate(s) _____ (#) Affidavit(s) Acknowledging Paternity
Complete information as it appears on the record:&
Full First Name
Full Middle Name&
Full Last Name&
If this record could be listed under any other name (due to legal name change or adoption) please list other possible names on record:
Date of Birth (mm/dd/yyyy)
Place of Birth (City or County)
Mother/Parent - Full First Name&
Full Middle Name&
Full Last Name&
Full Maiden Name&
Father/Parent - Full First Name&
Full Middle Name&
Full Last Name&
Full Maiden Name&
EXCESSIVE COPIES: Once four (4) or more certified copies of a birth certificate have been requested (lifetime) an additional Excessive
Copies Form must be completed for each additional request. This form is available on our website and must be notarized.
WYOMING MARRIAGE and/or DIVORCE RECORD — Record(s) Requested ($25 each):
_____ (#) Marriage Certificate(s) _____ (#) Divorce Certificate(s)
Complete information as it appears on the record:
Husband/Wife/Spouse - Full First Name
Full Middle Name
Full Last Name (At Time of the Event)
Husband/Wife/Spouse - Full First Name
Full Middle Name
Full Last Name (At Time of the Event)
Date of Event (mm/dd/yyyy)
Marriage: / / Divorce: / /
Place of Event (City or County)
Marriage: Divorce:
WYOMING DEATH RECORD—Record(s) Requested 1 for $25 plus _____ (#) for $20 each.
Complete information as it appears on the record:'
Full First Name
Full Middle Name
Full Last Name
Date of Death (mm/dd/yyyy)
Place of Death (City or County)
Date of Birth (mm/dd/yyyy)
REQUESTOR’S INFORMATION
Full First Name
Full Middle Name
Full Last Name
Mailing Address (Street or PO Box)
City
State
Zip Code
Contact Phone Number and/or Email Address
Please state your relationship to the person(s) named on the certificate(s)
requested:
ATTACH PHOTOCOPY OF A VALID
GOVERNMENT ISSUED ID HERE
(
Driver’s License, State ID Card, Passport, Tribal ID)
*If signature is located on the back, provide copies of both sides
**IDs less than 60 days expir
ed are still acceptable.
No staples please – clear tape is preferred.
OR
Provide notary information here.&
Purpose for requesting the certificate(s):
Signature of the Person Requesting Certificate(s) (Must be 18 or older)
► Date:
REQUESTS — WHO MAY HAVE COPIES:
Wyoming is a closed record state, meaning vital records are considered
confidential information and closed to the general public until one hundred (100) years after the date of birth or fifty (50)
years after the date of marriage, divorce, or death. Generally, only those listed on the record are entitled to receive
certified copies, though there are exceptions. Please refer to our website for more information on possible exceptions.
Individuals entitled to received certified copies of vital records are as follows:
Birth Certificates:
Registrant (child named on
record), if of legal age (18 years
or older)
Either parent named on the
certificate
Lawyer representing either the
registrant or the parent(s) *
Legal guardian with certified
copy of the guardianship papers
(obtained from a Court) *
Unemancipated Minor with
signed affidavit *
Marriage / Divorce Certificates:
Either party named on the
certificate
Lawyer representing either
party *
Death Certificates:
Immediate family members (parent,
current spouse, child)
Lawyer representing the immediate
family *
A bank, executor of the estate,
insurance company, or anyone
requiring a certificate to pay a policy or
death benefit on the decedent
*
In some cases, individuals or
organizations may be authorized to
obtain a certificate when determining a
personal or property right
*
* The applicant must demonstrate the requirement for the certificate
GENEALOGY REQUESTS:
Written verifications of a record may be issued for genealogical research if the record
requested is a closed record. In order to obtain a verification of a closed record, the requestor must provide evidence that
the individual(s) listed on the record are deceased (provide copies of death certificates) as well as documentation showing
how the requestor is related to the person listed on the record (through copies of birth and marriage records). Verifications
are a redacted version of the full record and may not contain all the information available on the original.
IDENTIFICATION REQUIRED:
The requestor must include a photocopy of a valid government issued picture
identification that includes a permanent signature with their request. IDs less than 60 days expired are still acceptable.
The validity of the identification submitted is determined by Vital Statistics Services. A notarized signature on the front of
this form may take the place of an ID. Please refer to our website for more information on possible exceptions.
Accepted Government Issued IDs:
Driver’s License
Passport Card
Retired or Dependent Military ID
State ID Card
Tribal ID
U.S. Concealed Weapons Permit
Passport
Consular Card
State or Federal Prison Corrections ID
DESCRIPTION OF CERTIFIED COPIES:
Standard certified copies of vital records are computer generated (abstracts)
and are acceptable for all legal purposes including but not limited to: Government Agencies (Department of Motor
Vehicles, Passport, etc.), Insurance Companies, and Educational Institutions.
SUBMITTING THE REQUEST:
Mail this completed form to the address listed on the front. Ensure you have signed the
request, attached a photocopy of your identification, included a payment in the correct amount to cover the cost of your
request(s), and provided a
SELF-ADDRESSED STAMPED ENVELOPE
to mail the records requested to you. Checks
or money orders should be made payable to Vital Statistics Services. The check must be bank-personalized and on the
account of the person making the request.
Cash is also accepted but not recommended. If your request requires the
Excessive Copies Form (4 or more certificates requested in a lifetime) please be sure to include this form as well.
Fees – Certified Copies
Fees
# of
Copies
Sub-total
Cost
Birth, Marriage, Divorce, Stillbirth
$25.00
Death - First Copy (per request)
$25.00
Death - Each Additional Copy
$20.00
Death Search – Per 5 years searched. Fee covers one certified copy if found
$35.00
Search - For every five (5) years searched. Fee covers one certified copy if found.
$30.00
Photocopy of a Certificate
$30.00
Adoption; Court Ordered Change, Correction or Amendment; Court Order of Paternity
$55.00
Corrections (not involving a court ordered action)
$20.00
Affidavit Acknowledging Paternity
$25.00
Replacement Certificate Following a Correction (Previously issued certificate must be returned.)
$15.00
Self Addressed Stamped Envelope
Cash Check Money Order
Total
Vital Statistics Services • 2300 Capitol Avenue • Cheyenne, WY 82002
