Form VR201 "Application for a Certified Copy of a Vital Record" - New Hampshire

What Is Form VR201?

This is a legal form that was released by the New Hampshire Secretary of State - a government authority operating within New Hampshire. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2020;
  • The latest edition provided by the New Hampshire Secretary of State;
  • 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 VR201 by clicking the link below or browse more documents and templates provided by the New Hampshire Secretary of State.

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Download Form VR201 "Application for a Certified Copy of a Vital Record" - New Hampshire

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APPLICATION FOR A CERTIFIED COPY OF A VITAL RECORD
Print
New Hampshire Department of State
Reset
Division of Vital Records Administration
9 Ratification Way
Concord, NH 03301-2455
REGISTRANT EVENT(S)
Please complete online prior to signing!
Birth
Number of copies ____ (first copy issued at $15.00; each additional copy, $10.00)
Name of Child
Child’s Sex
Father’s/Parent’s Full (Maiden) Name
Child’s Birthdate
Mother’s/Parent’s Full (Maiden) Name
Child’s Birthplace
_______
Death
Number of copies ____ (first copy issued at $15.00; each additional copy, $10.00)
Full Name of Deceased
Sex
Date of Death
Place of Death
Issued
With /
Without Cause of Death
Marriage / Civil Union
Number of copies ____ (first copy issued at $15.00; each additional copy, $10.00)
Prior Full Name of Groom/Person A
Date of Marriage/Civil Union
Prior Full Name of Bride/Person B
Place of Marriage/Civil Union
Divorce / Civil Union Dissolution
Number of copies ____ (first copy issued at $15.00; each additional copy, $10.00)
Full Name of Husband/Person A
Date of Decree
Full Name of Wife/Person B
Place of Decree (County)
New Hampshire law
(RSA
5-C:10) requires that a nonrefundable search fee be collected for each record requested. If the
record is located and you meet eligibility requirements, you will be issued the requested number of certified copies of that
record.
Applicant’s
Name:
(FIRST)
(MIDDLE)
(LAST)
Applicant’s
Address:
(ATTENTION INFORMATION/BUSINESS NAME)
(STREET)
(APT)
(CITY/TOWN)
(STATE)
(COUNTRY)
(ZIP CODE)
Applicant’s
Phone No.:
Email:
(AREA CODE & NUMBER)
Reason for Certificate Request:
IF the Certificate is for a Foreign Consulate, you should
CLICK
HERE.
Applicant’s
Your relationship as applicant
Signature:
to the Registrant:
(Original signature is required.)
NOTICE: Any person shall be guilty of a CLASS B Felony if he/she willfully and knowingly makes any false statement in an application for a
certified copy of a vital record.
(RSA
5-C:14)
PLEASE NOTE: A LEGIBLE PHOTOCOPY OF THE APPLICANT’S GOVERNMENT ISSUED PHOTO ID MUST BE INCLUDED WITH
THIS REQUEST (i.e. driver’s license, non-driver’s ID, passport). IF THE APPLICANT DOES NOT POSSESS A PHOTO ID, THEY
SHOULD
CLICK
HERE. YOU MUST PROVIDE EVIDENCE THAT THE ADDRESS TO WHICH THE VITAL RECORD IS TO BE SENT IS
INDEED YOUR ADDRESS (eg. personal check, driver’s license, utility bill), OTHERWISE
CLICK HERE
AND FILL OUT THE BOTTOM
HALF.
DO NOT SEND CASH. PLEASE MAKE CHECKS PAYABLE TO: Treasurer-State of New Hampshire
I have enclosed a stamped, self-addressed, business-letter-sized envelope.
DID YOU…
OFFICIAL USE ONLY:
Sign the Application?
NBR
Incl. a photocopy of Gov Issued ID?
TYPE(S)/AMT(S)
Enclose Payment?
ISSUED
If not, application must be returned!
Rev. 08/20 VR201
APPLICATION FOR A CERTIFIED COPY OF A VITAL RECORD
Print
New Hampshire Department of State
Reset
Division of Vital Records Administration
9 Ratification Way
Concord, NH 03301-2455
REGISTRANT EVENT(S)
Please complete online prior to signing!
Birth
Number of copies ____ (first copy issued at $15.00; each additional copy, $10.00)
Name of Child
Child’s Sex
Father’s/Parent’s Full (Maiden) Name
Child’s Birthdate
Mother’s/Parent’s Full (Maiden) Name
Child’s Birthplace
_______
Death
Number of copies ____ (first copy issued at $15.00; each additional copy, $10.00)
Full Name of Deceased
Sex
Date of Death
Place of Death
Issued
With /
Without Cause of Death
Marriage / Civil Union
Number of copies ____ (first copy issued at $15.00; each additional copy, $10.00)
Prior Full Name of Groom/Person A
Date of Marriage/Civil Union
Prior Full Name of Bride/Person B
Place of Marriage/Civil Union
Divorce / Civil Union Dissolution
Number of copies ____ (first copy issued at $15.00; each additional copy, $10.00)
Full Name of Husband/Person A
Date of Decree
Full Name of Wife/Person B
Place of Decree (County)
New Hampshire law
(RSA
5-C:10) requires that a nonrefundable search fee be collected for each record requested. If the
record is located and you meet eligibility requirements, you will be issued the requested number of certified copies of that
record.
Applicant’s
Name:
(FIRST)
(MIDDLE)
(LAST)
Applicant’s
Address:
(ATTENTION INFORMATION/BUSINESS NAME)
(STREET)
(APT)
(CITY/TOWN)
(STATE)
(COUNTRY)
(ZIP CODE)
Applicant’s
Phone No.:
Email:
(AREA CODE & NUMBER)
Reason for Certificate Request:
IF the Certificate is for a Foreign Consulate, you should
CLICK
HERE.
Applicant’s
Your relationship as applicant
Signature:
to the Registrant:
(Original signature is required.)
NOTICE: Any person shall be guilty of a CLASS B Felony if he/she willfully and knowingly makes any false statement in an application for a
certified copy of a vital record.
(RSA
5-C:14)
PLEASE NOTE: A LEGIBLE PHOTOCOPY OF THE APPLICANT’S GOVERNMENT ISSUED PHOTO ID MUST BE INCLUDED WITH
THIS REQUEST (i.e. driver’s license, non-driver’s ID, passport). IF THE APPLICANT DOES NOT POSSESS A PHOTO ID, THEY
SHOULD
CLICK
HERE. YOU MUST PROVIDE EVIDENCE THAT THE ADDRESS TO WHICH THE VITAL RECORD IS TO BE SENT IS
INDEED YOUR ADDRESS (eg. personal check, driver’s license, utility bill), OTHERWISE
CLICK HERE
AND FILL OUT THE BOTTOM
HALF.
DO NOT SEND CASH. PLEASE MAKE CHECKS PAYABLE TO: Treasurer-State of New Hampshire
I have enclosed a stamped, self-addressed, business-letter-sized envelope.
DID YOU…
OFFICIAL USE ONLY:
Sign the Application?
NBR
Incl. a photocopy of Gov Issued ID?
TYPE(S)/AMT(S)
Enclose Payment?
ISSUED
If not, application must be returned!
Rev. 08/20 VR201