"Application for a Certified Copy of Birth Certificate or Verification" - Nevada

Application for a Certified Copy of Birth Certificate or Verification is a legal document that was released by the Nevada Department of Health and Human Services - a government authority operating within Nevada.

Form Details:

  • Released on October 15, 2020;
  • The latest edition currently provided by the Nevada Department of Health and Human Services;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Nevada Department of Health and Human Services.

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Download "Application for a Certified Copy of Birth Certificate or Verification" - Nevada

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PPLICATION FOR
ERTIFIED
OPY OF
IRTH
ERTIFICATE
R
ERIFICATION
N
C
C
C
B
C
F
:
UMBER OF
OPIES
ERTIFIED
OPY OF
IRTH
ERTIFICATE
EE
$25.00 per Certificate
T
C
YPE OF
ERTIFICATE
(Please check one type box below)
Certificate(s) to read as “Mother / Father”
Certificate(s) to read as “Parent / Parent”
X
V
O
(
ERIFICATION
NLY
Verifies the existence of a record with the State of Nevada and does not include a certified copy.)
Search/Verification
- $10.00 per search /verification
Paternity Letter -
$10.00 per search /verification
M
P
P
:
AKE
AYMENT
AYABLE TO
Office of Vital Records. Checks, money orders and credit cards are accepted. Please include the
“Authorization for Credit Card Use” form and the card holder’s identification if paying by credit card. CASH FOR WALK-IN CUSTOMERS
ONLY.
A C
A
P
I
F
P
R
R
. P
OPY OF THE
PPLICANT
S
HOTO
DENTIFICATION AND
ULL
AYMENT IS
EQUIRED FOR ALL
EQUESTS
ROOF OF
R
R
C
R
.
ELATIONSHIP IS
EQUIRED FOR
ERTIFICATE
EQUESTS
Person on the Certificate’s Information
First
Middle
Last
Date of Birth
County of Birth
State of Birth
Parent 1’s First & Last Name
Parent 2’s First and Last Name
Last Name Prior to First Marriage
NRS 440.650 and NAC 440.070 requires the applicant to establish a direct relationship by blood or marriage, a legal relationship or a
need to facilitate a legal process to receive a certified copy of a certificate. Below, indicate your relationship or your legal need for this
certificate. Please provide proof such as a birth certificate or court order. Unless the applicant is the informant, listed surviving spouse,
or a parent listed on the certificate, the request will be rejected if sufficient proof is not provided. Visit our website listed below for
more information regarding proof required.
Relationship to Person of Record
Reason for Request
Applicant’s Printed Name
Applicant’s Signature
Applicant’s Address (Number and Street)
City
State
ZIP
Applicant’s Phone Number
FOR OFFICE USE ONLY
Receipt/Applicant ID Number:
Date:
Rev. 10/15/2020
Office of Vital Records and Statistics Attn: Customer Service
4150 Technology Way, Suite 104 ● Carson City, Nevada 89706
775-684-4242 ● Fax 775-684-4156 ● dpbh.nv.gov/Vital Records
Page 1 of 1
A
A C
C
B
C
O
V
PPLICATION FOR
ERTIFIED
OPY OF
IRTH
ERTIFICATE
R
ERIFICATION
N
C
C
C
B
C
F
:
UMBER OF
OPIES
ERTIFIED
OPY OF
IRTH
ERTIFICATE
EE
$25.00 per Certificate
T
C
YPE OF
ERTIFICATE
(Please check one type box below)
Certificate(s) to read as “Mother / Father”
Certificate(s) to read as “Parent / Parent”
X
V
O
(
ERIFICATION
NLY
Verifies the existence of a record with the State of Nevada and does not include a certified copy.)
Search/Verification
- $10.00 per search /verification
Paternity Letter -
$10.00 per search /verification
M
P
P
:
AKE
AYMENT
AYABLE TO
Office of Vital Records. Checks, money orders and credit cards are accepted. Please include the
“Authorization for Credit Card Use” form and the card holder’s identification if paying by credit card. CASH FOR WALK-IN CUSTOMERS
ONLY.
A C
A
P
I
F
P
R
R
. P
OPY OF THE
PPLICANT
S
HOTO
DENTIFICATION AND
ULL
AYMENT IS
EQUIRED FOR ALL
EQUESTS
ROOF OF
R
R
C
R
.
ELATIONSHIP IS
EQUIRED FOR
ERTIFICATE
EQUESTS
Person on the Certificate’s Information
First
Middle
Last
Date of Birth
County of Birth
State of Birth
Parent 1’s First & Last Name
Parent 2’s First and Last Name
Last Name Prior to First Marriage
NRS 440.650 and NAC 440.070 requires the applicant to establish a direct relationship by blood or marriage, a legal relationship or a
need to facilitate a legal process to receive a certified copy of a certificate. Below, indicate your relationship or your legal need for this
certificate. Please provide proof such as a birth certificate or court order. Unless the applicant is the informant, listed surviving spouse,
or a parent listed on the certificate, the request will be rejected if sufficient proof is not provided. Visit our website listed below for
more information regarding proof required.
Relationship to Person of Record
Reason for Request
Applicant’s Printed Name
Applicant’s Signature
Applicant’s Address (Number and Street)
City
State
ZIP
Applicant’s Phone Number
FOR OFFICE USE ONLY
Receipt/Applicant ID Number:
Date:
Rev. 10/15/2020
Office of Vital Records and Statistics Attn: Customer Service
4150 Technology Way, Suite 104 ● Carson City, Nevada 89706
775-684-4242 ● Fax 775-684-4156 ● dpbh.nv.gov/Vital Records
Page 1 of 1