Fill - Free fillable - Vital Certificate Request Form 03-12-19 PDF form

VitalRecordsCertifiedCopyRequestForm

LisaBrown,OaklandCountyClerk•1200N.TelegraphRd.,Pontiac,MI48341•248‐858‐0571

SAVETIME–GOONLINE•www.oakgov.com/clerkrod

REQUESTOR’SINFORMATION

Name:



DaytimePhone:

Address:



City,State,Zip:

Signature:

Date:

(Mustbesignedtoprocessrequest)

Birth/Death/MarriageRecordFees:$15.00firstcopy,$5.00eachadditionalcopyofsamerecord.

BirthRecordFees(65YearsorOlderofyourownrecord):$10.00firstcopy,$5.00eachadditionalcopyofsamerecord.

~Nochecks~



BIRTHRECORDS

(forbirthsthatoccurredin

OaklandCount



Numberofcopiesrequested:

 PhotoIdentificationmustbepresentedwiththisrequestoracopymailedwiththisrequest.

 Birthcertificatemaynotbeavailablefor45‐60daysafterchild’sbirth.

FullNameofPersononRecord:

Checkif65or

older

DateofBirth:

CityofBirth:

Mother’sFullMaidenName:

Father’sName:

Ifrequestor’snameisdifferentthanthenameasitappearsonthebirthrecord,pleaseprovide:

1. Dateofmarriage:_______________________2.Placeofmarriage(State):_______________________

Eligibility

–

YoumustbeeligibletorequestthisbirthrecordperMCL333.2882*.Checktheboxthatappliestoyou:

Personnamedonrecord

Parentnamedonrecord

LegalGuardian(guardianshippapersrequired)

Courtofcompetentjurisdiction(courtorderrequired)

LegalLicensedRepresentative(letterofrepresentationrequired)

Birthrecordisatleast100yearsold

Heirofdeceasedpersonnamedonrecord

–

Relationship/DateandPlaceofDeath:___________________________



*PENALTIES:Anyonewhoobtainsorattemptstoobtainavitalrecordofanotherpersonwiththeintenttocommitidentitytheftorcommit

anothercrimeisguiltyofafelonypunishablebyimprisonmentforuptofiveyearsand/orafineofupto$25,000.

DEATHRECORDS

(fordeathsthatoccurredin

OaklandCounty)

Numberofcopiesrequested:

NameofDeceased:

DateofDeath:

CityofDeath:

MARRIAGERECORDS

(formarriagelicensesobtainedin

OaklandCount



Numberofcopiesrequested:

First Middle LastNameatBirthorMaiden

Marriagebetween(asappearson record):

And(asappearsonrecord):

DateofMarriage:

First Middle LastNameatBirthorMaiden

Rev.3/12/19

Forofficeuseonly:File#____________Clerk’sInitials______I.D.Verification:DL____StateID____Other____

Fill Online, Printable, Fillable, Blank - Vital Certificate Request Form 03-12-19 Form

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Fillable - Vital Certificate Request Form 03-12-19

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