First Middle Last Male Female
Date of Birth (mm/dd/yy) OKLAHOMA Birth City and/or County If child is less than age 2, List the name of Hospital or Midwife
Father’s First Name Father’s Middle Name Father’s Last Name
Mother’s First Name Mother’s Middle Name Mother’s Maiden Last Name (prior to rst marriage)
STEP 1 - In order to accept this form, please read the following requirements:
• This request must be completed in full (request will not be processed without the signature and photocopy of a legal photo
I.D. of the applicant, full fees, and established eligibility of the applicant)
• Enclose a copy of a current legal photo I.D. of the applicant (see back for a list of acceptable I.D.s)
• Enclose all the appropriate fees and include a self-addressed stamped envelope (see back for mailing address)
OKLAHOMA BIRTH CERTIFICATE REQUEST FORM
( )
-
A NON-REFUNDABLE /
NON-TRANSFERABLE record search fee
of $15 includes the issuance of one
certied copy if the record is found;
additional copies are $15 each.
If no record is found, the fee will not
be refunded. Should you receive a
request for more information, please
respond promptly as all fees will
expire one year after the date paid.
STEP 2 - Complete the Order Information below:
QTY PRICE SUB-TOTAL
ITEM DESCRIPTION
Standard certified copy request ($15 each and includes search fee)
Delayed registration, amendment, paternity, adoption, or legitimation
requests only (one-time initial fee and includes one certified copy)
Special Commemorative Heirloom Birth Certificate
TOTAL AMOUNT ENCLOSED
DO NOT SEND CASH BY MAIL - Make checks payable to OSDH
$15
$40
$35
STEP 3 - Final Check & Sign
Reviewed By: Date: / /
Fees Enclosed: $ Fees Due: $
ID Enclosed:
Clerk: Date: / /
Fees Paid: $ Check Cash MO CC
OFFICE USE ONLY
Mail
Complete the fields below starting with the FULL NAME AT BIRTH: (If the birth name was legally changed, please see instructions on back)
• Check to see if you have lled out all of the information elds and you have followed all instructions in Step 1.
• By signing below, you declare that all information provided on this request is true and correct:
Signature Date Signed
Purpose for which the birth
certificate is needed:
Driver’s License Social Security Passport School State Assistance Pgm Other:
This request is being made by:
(see eligibility instructions on back)
Subject of the record Parent Legal Guardian or Custodian Authorized Agent, specify:
Your Name Daytime Telephone Number
Current Mailing Address (Required) APT# City / State / Zip
E-mail Address
No Email
BIRTH CERTIFICATE REQUEST INSTRUCTION SHEET
AVAILABLE RECORDS
Oklahoma began ling death records in October of
1908; however ling did not become mandatory until
1917. Prior to 1940 ling continued to be somewhat
sporadic, which may prove problematic for families
who are requesting records for genealogy purposes.
ELIGIBILITY
By state law with limited exception (see OPEN RECORDS
below), birth records led with this oce are not open for
public inspection. The person requesting a birth certicate
must meet one of the following eligibility standards:
• Be the subject of the record
• Acting in such person’s best interest (and
authorized by the subject of the record)
• Court order
By signing the request, you are indicating that you are
the subject of the record, a court appointed legal
guardian, a custodial guardian, or an authorized agent
working in the best interest of the subject of record. If
the applicant is not the subject or a named parent on
the record, additional documentation will be
required. When
an adoption has occurred, the biological family and the
adoptee no longer have a legal right to the other’s birth
records apart from a court order or direct authorization.
For a complete list of eligibility requirements, go to:
• https://oklahoma.gov/health/birth-and-death-
certificates/birth-certificate-eligibility
ACCEPTABLE PHOTO IDENTIFICATION (ID)
A photocopy of a valid government issued photo ID by either the applicant or an
individual attesting for the applicant is required.
Note: Send a photocopy. Do not send your original ID.
Photocopies must be legible and cannot be expired.
• U.S. Issued Driver’s license or Identication card
• U.S. Passport containing the bearer’s signature
• Foreign Issued Passport with Visa (I-94)
• Government issued Military photo ID
• Tribal Photo ID Card containing the bearer’s signature
• Ok Self-Defense Act (SDA) License or Concealed Carry permit
• Resident Alien Card (Form I-551)
• Employment Authorization Card (Form I-766)
• Employment Authorization Card (Form I-688A)
• Temporary Resident Card (Form I-688)
• Oklahoma Dept of Corrections Consolidated Record Card (CRC)
In cases when a primary ID is not available, records may be requested with
two secondary identications; however, the record will only be mailed to the
applicant at the current address demonstrated on the identification.
For a complete list, go to https://oklahoma.gov/health/birth-and-death-
certificates/acceptable-identification
HEIRLOOM BIRTH CERTIFICATES
$35 fee includes one certied copy of the birth record
in addition to one Heirloom certicate.
The Heirloom Birth Certicate is 8 1/2 x 11” with a chocolate brown
and mint green color palette bearing a depiction of a Redbud,
the state tree. The certicate will reect the child’s name, date of
birth, gender, place of birth and the names of the parents.
OPEN RECORDS
Eective Nov 1, 2014, records of births occurring
at least 125 years ago are open record and
do not require proof of eligibility.
NAME CHANGES
If a change to the name of the subject of the birth record
has occurred as a result of legal action, the person
requesting the birth record must identify in the place
marked “full name at birth” the current legally altered
name of the subject of the birth record, and that name
must agree with the information that now appears on
the certicate. If a change needs to be made to the
record, complete the request with the information
that currently appears on the certicate and attach a
letter specifying the changes. (Additional Instructions
will be mailed once the request has been reviewed.)
SUBJECT OF THE BIRTH RECORD IS DECEASED
If the subject of the original Certicate of Birth is
deceased, the birth record will be marked with a notation
indicating that the subject of the record is deceased.
NOT BORN IN OKLAHOMA?
If you were not born in Oklahoma, please visit https://www.cdc.gov/nchs/w2w
for a complete listing of national vital statistics offices.
QUESTIONS?
If you have any questions, visit our official website:
vr.health.ok.gov
Lobbies are currently closed for walk ins.
Phone:
405.426.8880
MAIL YOUR APPLICATION TO:
This publication was issued by the Oklahoma State Department of Health (OSDH), an
equal opportunity employer and provider. A digital copy has been deposited with the
Publications Clearinghouse of the Oklahoma Department of Libraries and are available
for download at documents.ok.gov | 18008VR
Vital Recor
ds
Oklahoma State Department of Health
PO BOX 248964 • Oklahoma City, OK 73124-8964
Email
:
