Fillable Wisconsin Birth Certificate Application (City of Milwaukee)

Fill Online, Printable, Fillable, Blank Wisconsin Birth Certificate Application (City of Milwaukee) Form

Use Fill to complete blank online CITY OF MILWAUKEE (WI) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Wisconsin Birth Certificate Application (City of Milwaukee)

On average this form takes 15 minutes to complete

The Wisconsin Birth Certificate Application (City of Milwaukee) form is 2 pages long and contains:

  • 0 signatures
  • 18 check-boxes
  • 50 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Milwaukee

BROWSE CITY OF MILWAUKEE (WI) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
TYPE or PRINT.
DEPARTMENT OF HEALTH SERVICES
Division of Public Health
F-05291 (Rev. 11/2016)
STATE OF WISCONSIN
Wis. Stat. § 69.21
Page 1 of 2
WISCONSIN BIRTH CERTIFICATE APPLICATION
(for Mail or In-Person Requests)
PENALTIES: Any person who illegally possesses any vital record with knowledge that the vital record has been illegally obtained is guilty of a Class I felony [a fine of not more than
$10,000 or imprisonment of not more than 3 years and 6 months, or both, per Wis. Stat. § 69.24(1)].
I. APPLICANT INFORMATION
CURRENT NAME - First
Last
MAIL TO NAME - First (if different)
YOUR STREET ADDRESS (CANNOT be a P.O. Box address) Apt. No
MAIL TO ADDRESS (if different) Apt. No
City
State
ZIP Code
City
State
ZIP Code
DAYTIME TELEPHONE NUMBER
( )
EMAIL ADDRESS
TYPE OF CURRENT VALID PHOTO ID
(See item 4 on page 2.)
PHOTO ID NUMBER
STATE OF ISSUANCE
EXPIRATION DATE
II. APPLICANT’S RELATIONSHIP TO
PERSON NAMED ON THE CERTIFICATE
Per Wis. Stat. § 69.20(1), a CERTIFIED copy of a birth certificate is only available to those with a “direct and tangible interest." (A–E)
CHECK ONE box which indicates YOUR RELATIONSHIP to the PERSON NAMED on the birth certificate.
A. I am the PERSON NAMED on the birth certificate.
B. I am a member of the immediate family of the person named on the birth certificate.
Parent (My name is on the birth certificate and my parental rights have not been terminated.)
Brother / Sister Current Spouse Child
Maternal Grandparent Paternal Grandparent Current Domestic Partner (registered in the Wis. Vital Records System)
C. I am the legal custodian or guardian of the person named on the birth certificate.
D. I am a representative authorized by any person in category A, B or C, including an attorney.
Specify the person you represent: __________________________________________________________________________________
E. I can demonstrate the birth certificate is necessary for the determination or protection of a personal or property right.
Specify your interest: ___________________________________________________________________________________________
F. None of the above. I am requesting an uncertified copy. (Copy will not be valid for identity or legal purposes.)
NOTE: Grandchildren, stepparents, stepchildren and stepbrothers / stepsisters may only obtain certified copies as categories C-E.
PURPOSE FOR WHICH CERTIFICATE IS REQUESTED:
III. FEES
First Copy Fee …………………………………………….…….……………………………………………….…………... $ 20.00 __20.00____
Each additional copy of the same record, issued at the same time as the first copy ___________________ X $ 3.00 ___________
Number of additional copies
TOTAL ___________
Submit your application materials and fee to:
Be sure to include: completed form, acceptable identification,
payment,
any additional proof or authorization required
IV. BIRTH RECORD
INFORMATION
BIRTH NAME - First
Middle
Last Name as it appears on the birth certificate
SEX
Male Female
BIRTHDATE (MM/DD/YYYY)
PLACE OF BIRTH - County
PLACE OF BIRTH – City, Village, or Township
PARENT’S BIRTH NAME – First
Middle
Last
PARENT’S BIRTH NAME – First
Middle
Last
I hereby attest that the information provided on this application is correct to the best of my knowledge and belief and that I am entitled to copies of the
requested birth certificate in accordance to the categories listed above.
SIGNATURE (Applicant)
Date Signed (MM/DD/YYYY)
Important: Signature and payment are required for processing.
Clear / Reset Form
Register of Deeds, 901 N 9th St - Rm. 103, Milwaukee, WI 53233
Register of Deeds, 901 N. 9th St. - Rm. 103, Milwaukee, WI 53233
and a self addressed, stamped, business-size envelope
Payment must be a money order, cashier's check, personal check, or Credit Card**
WISCONSIN BIRTH CERTIFICATE APPLICATION
F-05291 (Rev. 11/2016)
Page 2 of 2
1. What is the difference between a “certified” and an “uncertified” copy of a birth certificate?
A CERTIFIED COPY:
Is printed on security paper, has a raised seal, and shows the signature of the State Registrar or Local Registrar.
Can be used for legal purposes.
Can only be obtained with a direct and tangible interest as defined in Wis. Stat. § 69.20(1).
AN UNCERTIFIED COPY:
Is printed on plain paper and marked “uncertified.”
Is for information purposes only and cannot be used for identity or legal purposes.
Contains the same information as a certified copy.
2. Limitations on access to certain birth certificates
According to Wis. Stat. ch. 69, uncertified copies of the following types of birth certificates may not be obtained by anyone:
A child born to unmarried parents and paternity has not been established.
A child born to unmarried parents and paternity was established by court order.
3. How long will it take to process my request?
APPLYING IN PERSON
APPLYING BY MAIL
4. What identification is required when applying for a birth certificate?
Requests for certified copies require proof of identification. Applicant’s original ID is required for in-person applications. A photocopy of
the applicant’s ID is required for mail applications.
At least one form of ID must show your name and address. Expired cards or documents will not be accepted.
Examples of acceptable forms of identification include:
One of these:
OR
Two of these:
State issued driver’s license or ID card
US or Foreign passport
Tribal or Military ID card
Bank/Earnings statement
Current, dated, signed lease
Health insurance card
US Government issued photo ID
Utility bill or traffic ticket
Vehicle registration/title
If you have questions regarding this form, please call
or visit our website at
Out of caution for the public and our staff, the lobby of the Register of Deeds Office is closed to the public until further notice.
Please check our website for updates: www.county.milwaukee.gov/EN/Register-of-Deeds.
If you need a document in an EMERGENCY situation, please call 414-278-4027 to make arrangements for an appointment.
**When paying by Credit Card a fee of $2.50 or 3% (whichever is greater) is applied to your order.
Please allow up to 2 weeks to receive your documents.
For faster service you may purchase on-line at www.Vitalchek.com (certified records only). Additional fees apply.
414-278-4027
www.county.milwaukee.gov/EN/Register-of-Deeds
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Wisconsin Birth Certificate Application (City of Milwaukee)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 22 January 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document