Application for Copy of Birth Certificate
Preston County, West Virginia
[Records available from 1869 to the present]
PLEASE NOTE: Print or type this form. Incomplete applications will not be accepted. All applicants
must be at least 18 years of age, with few exceptions.
Name at Birth:
First Middle Last
Date of Birth: Sex: Male; Female
Month/Day/Year
Place of Birth:
City County State
Father’s Full Name:
First Middle Last
Mother’s Full Maiden Name:
First Middle Last
Your relationship to the person whose birth record is requested: Certificate of my own birth;
Parent/Grandparent; Brother/Sister; Child/Grandchild; Spouse; Legal
Representative (i.e. attorney, physician, funeral director, etc.)
By my signature, I certify that the above marked relationship is true:
Signature Print Name Date
Number of Copies Requested: at $5.00 per copy – Total amount enclosed
Payment options - cash/certified or cashier’s check/money order - payable to “Preston County Clerk”.
Personal checks will not be accepted.
Send copies to (print your name, address and daytime telephone below):
Name Daytime Telephone Number
Street Address City State Zip Code
Return Application to:
Linda Huggins, County Clerk
Preston County Courthouse Annex
106 W. Main Street, Suite 103, Kingwood, WV 26537
Telephone (304) 329-0070 ~ Fax (304) 329-0198
Clerk’s Initials
