"Birth Certificate Application Form" - Montana

This printable "Birth Certificate Application Form" is a document issued by the Montana Department of Public Health and Human Services specifically for Montana residents.

Download a PDF of the latest edition of the form down below or find it through the department's forms library.

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Download "Birth Certificate Application Form" - Montana

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MONTANA VITAL RECORDS
111 N SANDERS RM 6 / PO BOX 4210
HELENA, MONTANA 59604-4210
Phone: 406-444-2685
PLEASE READ THESE INSTRUCTIONS CAREFULLY
WHO CAN ORDER A BIRTH CERTIFICATE?
Only those authorized by 50-15-121 MCA and 37.8.126 ARM, which includes the registrant (14 years old or older), the registrant’s spouse, children (with proof of
relationship), parents, grandparents (with proof of relationship), a caretaker relative, guardian, an authorized representative, or those who provide documentation
showing it is needed for determination or protection of the individuals personal or property rights. Proof of relationship, guardianship, caretaker relative, or
authorization is required to obtain a certify copy of a birth record.
Step-relatives, in-laws, aunts, uncles, cousins, ex-spouses, and a natural parent of an adoptive child are not eligible to receive a certified copy of a birth certificate.
IDENTIFICATION IS REQUIRED
The person signing the request must provide an enlarged legible photocopy of both sides of their valid driver’s license or other legal picture identification with a
signature or the requestor must have this application notarized.
Suggested Identification
Picture ID with a Signature
OR Two Forms of ID – One MUST have a Signature
OR
• Driver’s License
• Social Security Card
• Credit/Debit/ATM Card
Notarized Montana Office of Vital
• Work ID Card
• School ID Card
Statistics Statement to Identify certified
State ID Card
• Car registration/Insurance
Birth or Death Certificate Applicant form
Passport
Library Card
• Doctor/Medical record
(you must provide the original letter, not a
Military ID Card
Insurance Record
• Fishing License
photocopy or faxed copy)
Tribal
Pay Stub
• US Military DD214
Have an authorized family member that
Traffic/ Pawn ticket
• Utility Bill with a current address
has an ID order the certificate
Court record
• Voter Registration Card
Year Book
If a picture ID with a signature is not available, two other forms of identification are required; one MUST have a signature. Please include photocopies of both sides of
the ID when mailing your request. IMPORTANT: If the identification requirement is NOT met or if the application is incomplete, your request will be
returned and significant delays in processing your order may occur.
FEE (All fees must be U.S. funds)
CERTIFIED COPIES OF A BIRTH CERTIFICATE cost $12.00 for the first copy, $5.00 for each additional copy of the same record. (non-refundable)
INFORMATIONAL COPIES OF A BIRTH CERTIFICATE may be issued to anyone as long as the birth occurred 30 years prior to the date of application, the
cost is $10.00. (non-refundable)
CERTIFIED COPIES OF DOCUMENTS on file with the state (i.e. Acknowledgment of Paternity, correction affidavits), the cost is $12.00 (non-refundable)
SEARCHES: $10.00 for the first 5 years searched, then $1.00 per year over the first five years per name requested. (An informational copy will be issued if record
is found) (non-refundable)
Please Make CHECKS Payable To: MONTANA VITAL RECORDS
Please complete the following information.
FULL First, Middle and Last Name on Birth Certificate:
Has name ever been changed other than marriage
No
Yes If so, original name:
Date of Birth: _______________________Place of Birth (City or County): _________________________ Gender of Child:____________________
Mother’s Full Maiden Name:
Father’s Full Name:
Your relationship to the certificate holder:
(self, mother, father etc.)
# of copies needed
Reason Birth Certificate is needed:
Mailing or Delivery Address:
Name:
Address: ________________________________________________City, State, Zip: _______________________________________
Daytime Telephone Number: ___________________________ Signature of Applicant: ___________________________________
Email Address:_____________________________________________
Notary (For use if needed)
Verification of Signer’s ID Is Mandatory
Official Use Only
State of ________________________
County of ______________________
Date
Rec#
This record was signed and sworn to (or affirmed) before me on ___________________ by
(Date)
Amount
_______________________________
(Name of Applicant)
Cert #
Ser #
_______________________________
Comment
(Notary’s Signature)
[Official Stamp]
NOTICE: STATE LAW PROVIDES PENALTIES FOR PERSONS WHO WILLFULLY AND KNOWINGLY USE OR ATTEMPT TO USE THIS
CERTIFICATE FOR ANY PURPOSE OF DECEPTION. (50-15-114, MCA)
Print Form
Clear Form
MONTANA VITAL RECORDS
111 N SANDERS RM 6 / PO BOX 4210
HELENA, MONTANA 59604-4210
Phone: 406-444-2685
PLEASE READ THESE INSTRUCTIONS CAREFULLY
WHO CAN ORDER A BIRTH CERTIFICATE?
Only those authorized by 50-15-121 MCA and 37.8.126 ARM, which includes the registrant (14 years old or older), the registrant’s spouse, children (with proof of
relationship), parents, grandparents (with proof of relationship), a caretaker relative, guardian, an authorized representative, or those who provide documentation
showing it is needed for determination or protection of the individuals personal or property rights. Proof of relationship, guardianship, caretaker relative, or
authorization is required to obtain a certify copy of a birth record.
Step-relatives, in-laws, aunts, uncles, cousins, ex-spouses, and a natural parent of an adoptive child are not eligible to receive a certified copy of a birth certificate.
IDENTIFICATION IS REQUIRED
The person signing the request must provide an enlarged legible photocopy of both sides of their valid driver’s license or other legal picture identification with a
signature or the requestor must have this application notarized.
Suggested Identification
Picture ID with a Signature
OR Two Forms of ID – One MUST have a Signature
OR
• Driver’s License
• Social Security Card
• Credit/Debit/ATM Card
Notarized Montana Office of Vital
• Work ID Card
• School ID Card
Statistics Statement to Identify certified
State ID Card
• Car registration/Insurance
Birth or Death Certificate Applicant form
Passport
Library Card
• Doctor/Medical record
(you must provide the original letter, not a
Military ID Card
Insurance Record
• Fishing License
photocopy or faxed copy)
Tribal
Pay Stub
• US Military DD214
Have an authorized family member that
Traffic/ Pawn ticket
• Utility Bill with a current address
has an ID order the certificate
Court record
• Voter Registration Card
Year Book
If a picture ID with a signature is not available, two other forms of identification are required; one MUST have a signature. Please include photocopies of both sides of
the ID when mailing your request. IMPORTANT: If the identification requirement is NOT met or if the application is incomplete, your request will be
returned and significant delays in processing your order may occur.
FEE (All fees must be U.S. funds)
CERTIFIED COPIES OF A BIRTH CERTIFICATE cost $12.00 for the first copy, $5.00 for each additional copy of the same record. (non-refundable)
INFORMATIONAL COPIES OF A BIRTH CERTIFICATE may be issued to anyone as long as the birth occurred 30 years prior to the date of application, the
cost is $10.00. (non-refundable)
CERTIFIED COPIES OF DOCUMENTS on file with the state (i.e. Acknowledgment of Paternity, correction affidavits), the cost is $12.00 (non-refundable)
SEARCHES: $10.00 for the first 5 years searched, then $1.00 per year over the first five years per name requested. (An informational copy will be issued if record
is found) (non-refundable)
Please Make CHECKS Payable To: MONTANA VITAL RECORDS
Please complete the following information.
FULL First, Middle and Last Name on Birth Certificate:
Has name ever been changed other than marriage
No
Yes If so, original name:
Date of Birth: _______________________Place of Birth (City or County): _________________________ Gender of Child:____________________
Mother’s Full Maiden Name:
Father’s Full Name:
Your relationship to the certificate holder:
(self, mother, father etc.)
# of copies needed
Reason Birth Certificate is needed:
Mailing or Delivery Address:
Name:
Address: ________________________________________________City, State, Zip: _______________________________________
Daytime Telephone Number: ___________________________ Signature of Applicant: ___________________________________
Email Address:_____________________________________________
Notary (For use if needed)
Verification of Signer’s ID Is Mandatory
Official Use Only
State of ________________________
County of ______________________
Date
Rec#
This record was signed and sworn to (or affirmed) before me on ___________________ by
(Date)
Amount
_______________________________
(Name of Applicant)
Cert #
Ser #
_______________________________
Comment
(Notary’s Signature)
[Official Stamp]
NOTICE: STATE LAW PROVIDES PENALTIES FOR PERSONS WHO WILLFULLY AND KNOWINGLY USE OR ATTEMPT TO USE THIS
CERTIFICATE FOR ANY PURPOSE OF DECEPTION. (50-15-114, MCA)
Print Form
Clear Form
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