DHHS-VR-B (Revised 12/2018)
N.C. Vital Records
Application for a Copy of a North Carolina Birth Certicate
Full Name on Certicate
(If adopted, provide new information)
Date of Birth ____ | ____ | ________
Month Day Year
Sex Male Female
Were parents married
at time of birth? Yes No
Is this person deceased? Yes No
Place of Birth _________________________________________
City County
Full Name of Mother/Parent
(Adoptive parent, if applies)
First Name Middle Name Last Name Last Name prior to rst marriage, if applies
Full Name of Father/Parent
(Adoptive parent, if applies)
First Name Middle Name Last Name Last Name prior to rst marriage, if applies
Check all boxes that apply; add the fees in 1–3
and place the total amount in #4.
See further instructions on Page 2.
Your Relationship to the Person Whose Certicate is Requested:
(Check One)
1. Order Certicate
Processing times vary.
Check website for current information.
(Non-refundable fee)
Certicate Search and First Copy ($24) $ ______
#____ additional copies x $15 $ ______
(Suitable for legal purposes)
(Not suitable for legal purposes)
Spouse (Current)
Authorized agent, attorney or legal representative of
the person listed (Proof REQUIRED)
Other (may not be entitled to a certied copy)
(Please Print)
: ______________________________________________________________
Print Name of Person Requesting the Certicate
Address: ______________________________________________________________
Street Address (P.O. Box cannot be used for expedited shipping)
P.O. Box (If mailing to a P.O. Box, street address must also be listed above)
City, State and Zip Code
(Area Code) Telephone Number (During business hours)
Email Address: ___________________________________________________________
Payment: Please pay with a cashiers check or money order made payable to N.C. Vital
Records. Personal checks are not accepted. Requests that are submitted with no payment
or incomplete payment or incomplete information will be returned. Credit card payment is
available for walk-in customers.
See Page 2 for a list of acceptable IDs.
2. Record Changes (Only if applies)
Appointment required for in-person services.
($15 non-refundable processing fee)
Adoption $ ______
Amendment $ ______
Name Change $ ______
Legitimation Court Order $ ______
Legitimation (mother married father
after child’s birth) $ ______
Paternity (no fee) $
Other _____________________ $ ______
3. Faster Service (Choose only one)
Optional for mail-in requests - Must write “Expedite”
on the outside of the envelope.
($15 non-refundable expedite fee)
Walk-in Service ($15) $ ______
Expedited Processing ($15) $ ______
(Shipped by regular mail)
Expedited Processing and
Expedited Shipping ($35) $ ______
(Call for expedited shipping fees outside the continental United States)
4. Total Fees
(Add 1+2+3 above for total) $ ______
I hereby certify that all the above information is true to the best of my knowledge. Note: It is a felony violation of North Carolina Law (G.S.
130A-26A) to make a false statement on this application or to unlawfully obtain a copy or a certied copy of a birth certicate.
___________________________________________________________ ______________________________________________
Signature of Person Requesting the Certicate Date Signed
Ofce Use Only: SFN _______________________________ DCN _____________________________ Cartridge/Frame _______________________________________
Amount received: $_______________________ Identication presented_______________________________________________________________________________
Request number ___________________________________________ Request date _____________________________________________________________________
— — — — — CUSTOMER MUST COMPLETE — — — — — —
How do you plan to use this record?
First Name Middle Name Last Name
North Carolina Department of Health and Human Services
Division of Public Health • N.C. Vital Records
Telephone: 919-733-3000
Mail: 1903 Mail Service Center
Raleigh, NC 27699-1900
Location: 225 North McDowell St.
Raleigh, NC 27603-1382
DHHS-VR-B (Revised 12/2018)
N.C. Vital Records
Order Certicate
A certicate search costs $24 and includes one copy if the certicate is located. The search covers a three year
period. Requests are processed in the order received and can take up to ve weeks plus the mail delivery time.
The search fee is required to process a request and is non-refundable even if a record cannot be located.
Record Changes
Complete this section only if you are making a request to change information on the birth certicate. The $15
processing fee to review your request is non-refundable. In-person assistance for this service is by appointment
only. Please call (919) 792-5986 to schedule an appointment. If your request involves more than one birth
record, the $15 processing fee applies to each individual’s birth record that requires change(s).
Faster Service
To receive expedited service you MUST write “Expedite” on the outside of the envelope. This is a non-
refundable fee. For current processing times for expedited requests, see our website at https://vitalrecords.
Identication Requirement
Due to identity theft and other fraudulent use of vital records, ID of the person requesting a certicate is
REQUIRED. Requests that do not include ID will be returned. You MUST include a legible photocopy of
one of the photo IDs listed below with your request:
• Current state-issued drivers license (address must match requestors address on application)
• Current state-issued non-driver photo ID card (address must match requestors address on application)
• Current Passport or Visa (must include photo)
• Current U.S. military ID
• Current Department of Corrections photo ID card dated within the last year
• Current state or U.S. government agency photo ID card (for persons requesting certicates as part of that
agency’s business)
• Current student ID card with copy of transcript
If you do not have one of the IDs listed above, you must provide legible photocopies of TWO of the following
(must be two DIFFERENT forms of ID):
• Temporary drivers license
• Current utility bill with current address
• Car registration or title with current address
• Bank statement with current address
• Pay stub with current address
• Income tax return/W-2 form showing current address
• Letter from government agency dated within the last six months and showing current address
• State-issued concealed weapon permit showing current address
If you are unable to meet our ID requirements, a family member or other person
who is entitled to obtain the certicate, and who can meet the ID requirements, may request it.
A list of persons entitled to obtain certicates is located on our website at