RODACC – Revised 051607
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
CERTIFIED COPY OF VITAL RECORDS.
DOCUMENTATION OF AUTHORITY MUST BE INCLUDED WITH THE REQUEST FOR
AUTHORIZED AGENT, ATTORNEYS OR LEGAL REPRESENTATIVES (N.C.G.S. 130A-93
AND -99)
APPLICATION FOR CERTIFIED COPY
BIRTH CERTIFICATE
Name at Birth ________________________________________________________________________
Date of Birth _______________________ Place of Birth ____________________________________
Father’s Full Name ____________________________________________________________________
Mother’s Full Maiden Name ____________________________________________________________
DEATH CERTIFICATE
Full Name of Deceased ________________________________________________________________
Date of Death ______________________ Place of Death ____________________________________
MARRIAGE CERTIFICATE
Name of Groom ______________________________________________________________________
Full Maiden Name of Bride _____________________________________________________________
Date of Marriage __________________ Place of Marriage __________________________________
RELATIONSHIP TO REGISTRANT ___________________________________________________
self, spouse, sibling, parent, grandparent, child, step-parent,
step-child, grandchild, other)
A COPY OF A VALID DRIVER’S LICENSE OR GOVERNMENT ISSUED PICTURE I.D. IS
REQUIRED.
Certified copies are $10.00
Amount enclosed ___________ Please forward money order, cashiers check or cash (NO PERSONAL
CHECKS) to:
Craven County Register of Deeds
226 Pollock St.
New Bern, NC 28560
______________________________________ __________________________________________
Applicant’s Signature REQUIRED Applicant’s typed or printed name
_____________________________________________________________________________________
Applicant’s mailing address
PLEASE PROVIDE A SELF ADDRESSED STAMPED ENVELOPE
