Form SFN8140 "Request for Certified Copy of a Birth Record" - North Dakota

What Is Form SFN8140?

This is a legal form that was released by the North Dakota Department of Health - a government authority operating within North Dakota. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2021;
  • The latest edition provided by the North Dakota Department of Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form SFN8140 by clicking the link below or browse more documents and templates provided by the North Dakota Department of Health.

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Download Form SFN8140 "Request for Certified Copy of a Birth Record" - North Dakota

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REQUEST FOR CERTIFIED COPY OF A BIRTH RECORD
NORTH DAKOTA DEPARTMENT OF HEALTH
DIVISION OF VITAL RECORDS
SFN 8140 (10-2021)
PLEASE PRINT - ALL ITEMS MUST BE COMPLETED AND LEGIBLE TO LOCATE AND IDENTIFY THE RECORD
2. Sex
1. Full Name on Birth Record (If adopted, list adoptive name)
Male
Female
3. Date of Birth (Month, Day, Year)
4. Place of Birth (City, Township or County)
5. Full Name of Father (First, Middle, Last) (If adopted, list adoptive father/parent name)
6. Full Name of Mother (First, Middle, Maiden) (If adopted, list adoptive mother/parent name)
7. Number of Certified Copies Requested ($15.00 per copy requested)
8. Fees: (Check or Money Order)
Certified (For all official purposes, including U.S. Passport, Driver’s License, etc.)
$
.00
Genealogy (For researching family history - not available for births occurring after 2005)
9. Requestor Relationship to Person on Line 1*
Self
Mother/Father
Public
Authorized Rep
(must be 16 or older)
(Only if record is over 125 years old)
(include court order)
Legal Guardian (must include guardianship papers - Social Services must also include employment photo ID)
* If individual on line #1 is deceased, you must include a certified death certificate (which will be returned) and indicate your relationship.
spouse,
parent,
child,
grandparent, or
grandchild
Requestor MUST COMPLETE and SIGN and include their name, address and telephone number.
Requestor Signature
Date Signed
Daytime Telephone Number
Requestor Printed Name
(
)
Mailing Address (please include your Apartment Number, if applicable)
Apartment Number
City
State
ZIP Code
Shipping Options: (First Class Mail is the no cost default)
First Class Mail
FedEx - $20 (Add $6 for AK or HI)
UPS - $15
USPS Priority Mail - $10-USA Only
FedEx/UPS International - $50
Waive Signature - FedEx or UPS
IDENTIFICATION REQUIRED - Requestor must submit A) One Primary form of ID; OR B) Two Secondary forms of ID;
OR C) Submit a Notarized application. (Choose A or B or C) - Instructions for identification listed on back of the form)
Date Subscribed and Sworn Before Me
My Commission Expires
County
State
SEAL
Signature of Notary Public
Warning - NDCC 23-02.1-32(c) Penalties. Any person who willfully or knowingly uses or attempts to use or to furnish to another for use,
for any purpose of deception, any certificate, record, report, or certified copy thereof so made, altered, amended or mutilated shall be
guilty of a class C felony.
PLEASE DO NOT ENTER ANYTHING BELOW THE LINE - THIS PORTION FOR OFFICIAL VITAL RECORDS OFFICE USE ONLY
Identification Verified
Fee Received
REQUEST FOR CERTIFIED COPY OF A BIRTH RECORD
NORTH DAKOTA DEPARTMENT OF HEALTH
DIVISION OF VITAL RECORDS
SFN 8140 (10-2021)
PLEASE PRINT - ALL ITEMS MUST BE COMPLETED AND LEGIBLE TO LOCATE AND IDENTIFY THE RECORD
2. Sex
1. Full Name on Birth Record (If adopted, list adoptive name)
Male
Female
3. Date of Birth (Month, Day, Year)
4. Place of Birth (City, Township or County)
5. Full Name of Father (First, Middle, Last) (If adopted, list adoptive father/parent name)
6. Full Name of Mother (First, Middle, Maiden) (If adopted, list adoptive mother/parent name)
7. Number of Certified Copies Requested ($15.00 per copy requested)
8. Fees: (Check or Money Order)
Certified (For all official purposes, including U.S. Passport, Driver’s License, etc.)
$
.00
Genealogy (For researching family history - not available for births occurring after 2005)
9. Requestor Relationship to Person on Line 1*
Self
Mother/Father
Public
Authorized Rep
(must be 16 or older)
(Only if record is over 125 years old)
(include court order)
Legal Guardian (must include guardianship papers - Social Services must also include employment photo ID)
* If individual on line #1 is deceased, you must include a certified death certificate (which will be returned) and indicate your relationship.
spouse,
parent,
child,
grandparent, or
grandchild
Requestor MUST COMPLETE and SIGN and include their name, address and telephone number.
Requestor Signature
Date Signed
Daytime Telephone Number
Requestor Printed Name
(
)
Mailing Address (please include your Apartment Number, if applicable)
Apartment Number
City
State
ZIP Code
Shipping Options: (First Class Mail is the no cost default)
First Class Mail
FedEx - $20 (Add $6 for AK or HI)
UPS - $15
USPS Priority Mail - $10-USA Only
FedEx/UPS International - $50
Waive Signature - FedEx or UPS
IDENTIFICATION REQUIRED - Requestor must submit A) One Primary form of ID; OR B) Two Secondary forms of ID;
OR C) Submit a Notarized application. (Choose A or B or C) - Instructions for identification listed on back of the form)
Date Subscribed and Sworn Before Me
My Commission Expires
County
State
SEAL
Signature of Notary Public
Warning - NDCC 23-02.1-32(c) Penalties. Any person who willfully or knowingly uses or attempts to use or to furnish to another for use,
for any purpose of deception, any certificate, record, report, or certified copy thereof so made, altered, amended or mutilated shall be
guilty of a class C felony.
PLEASE DO NOT ENTER ANYTHING BELOW THE LINE - THIS PORTION FOR OFFICIAL VITAL RECORDS OFFICE USE ONLY
Identification Verified
Fee Received
SFN 8140 (10-2021)
Page 2 of 2
INSTRUCTIONS FOR OBTAINING A CERTIFIED COPY OF A BIRTH RECORD
The Division of Vital Records can issue copies of birth certificates only for births that occurred in North Dakota. We have
records on file starting with 1870 to the present. Proof of identification must be submitted by the requestor before we can
issue a certified copy of a birth record. The requestor must submit legible non-expired copies of either A) One PRIMARY
form of ID; or B) Two SECONDARY forms of ID; or C) Submit a NOTARIZED form. Specific instructions are below for each
option:
A) PRIMARY Identification options: (Must show Name, Date of Birth and Expiration Date. If this information is listed
on opposite sides of the ID, then we need a copy of both sides of the ID)
1. State Government issued Photo ID or Driver's License
2. Bureau of Indian Affairs issued tribal ID card
3. US Government issued Military ID card
4. US Government issued Passport or Visa
5. US Government issued Permanent Resident Card
B) Two SECONDARY Identification options: (We cannot accept two of the same documents. i.e., 2 bank statements)
1. Social Security Card
2. Medicare/Medicaid Card
3. Utility bill with the current address (within the last three months)
4. Bank Statement with the current address (within the last three months)
5. Pay Stub (within the last three months) or W-2 (issued for the previous tax year)
6. Motor Vehicle Registration Card for the current year with the current address
7. Tribal Enrollment Record - Issued by a Native American Tribe. Must contain Date of Birth.
C) Submit a NOTARIZED form:
1. Requestor MUST sign and date the form in the presence of a Notary Public.
2. The Notary Public must complete all five notary fields on the front of the form.
3. The Notary Public must sign the form and affix their notary seal in the space provided.
The fee for a search of the files is $15; one search fee pays for one certified copy. Please make your check or money
order payable to North Dakota Department of Health. We will issue a certified raised-seal paper copy for each copy
requested. Once received in our office, copies are usually mailed in 3 to 5 business days (this does not include the
mailing time). Certified copies CANNOT be faxed or emailed.
The certified copies will be sent by USPS First Class Mail unless you specify and include the additional funds for expedited
shipping options. Copies to be sent by Federal Express*, UPS* or USPS Priority Mail are processed the same day,
provided the request is in our office by 10:00 a.m. Central Time, otherwise they will be processed the next business day.
(*) - Federal Express and UPS cannot be used to send to U.S. PO Boxes
This form may be completed and mailed with fees to:
ND Department of Health
Division of Vital Records
600 East Boulevard Ave. Dept. 301
Bismarck, ND 58505-0200
Our web site is at: www.health.nd.gov
For questions, call our office at (701) 328-2360 or e-mail us at
vitalrec@nd.gov
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