VitalRecordsCertifiedCopyRequestForm
LisaBrown,OaklandCountyClerk1200N.TelegraphRd.,Pontiac,MI483412488580571
SAVETIMEGOONLINEwww.oakgov.com/clerkrod
REQUESTOR’SINFORMATION
Name:
DaytimePhone:
Address:
City,State,Zip:
Signature:
Date:
(Mustbesignedtoprocessrequest)
Birth/Death/MarriageRecordFees:$15.00firstcopy,$5.00eachadditionalcopyofsamerecord.
BirthRecordFees(65YearsorOlderofyourownrecord):$10.00firstcopy,$5.00eachadditionalcopyofsamerecord.
~Nochecks~
BIRTHRECORDS
(forbirthsthatoccurredin
OaklandCount
y)
Numberofcopiesrequested:
PhotoIdentificationmustbepresentedwiththisrequestoracopymailedwiththisrequest.
Birthcertificatemaynotbeavailablefor4560daysafterchild’sbirth.
FullNameofPersononRecord:
Checkif65or
older
DateofBirth:
CityofBirth:
Mother’sFullMaidenName:
Father’sName:
Ifrequestor’snameisdifferentthanthenameasitappearsonthebirthrecord,pleaseprovide:
1. Dateofmarriage:_______________________2.Placeofmarriage(State):_______________________
Eligibility
YoumustbeeligibletorequestthisbirthrecordperMCL333.2882*.Checktheboxthatappliestoyou:
Personnamedonrecord
Parentnamedonrecord
LegalGuardian(guardianshippapersrequired)
Courtofcompetentjurisdiction(courtorderrequired)
LegalLicensedRepresentative(letterofrepresentationrequired)
Birthrecordisatleast100yearsold
Heirofdeceasedpersonnamedonrecord
Relationship/DateandPlaceofDeath:___________________________
_
*PENALTIES:Anyonewhoobtainsorattemptstoobtainavitalrecordofanotherpersonwiththeintenttocommitidentitytheftorcommit
anothercrimeisguiltyofafelonypunishablebyimprisonmentforuptofiveyearsand/orafineofupto$25,000.
DEATHRECORDS
(fordeathsthatoccurredin
OaklandCounty)
Numberofcopiesrequested:
NameofDeceased:
DateofDeath:
CityofDeath:
MARRIAGERECORDS
(formarriagelicensesobtainedin
OaklandCount
y)
Numberofcopiesrequested:
First Middle LastNameatBirthorMaiden
Marriagebetween(asappearson record):
And(asappearsonrecord):
DateofMarriage:
First Middle LastNameatBirthorMaiden
Rev.3/12/19
Forofficeuseonly:File#____________Clerk’sInitials______I.D.Verification:DL____StateID____Other____
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome