Form VS-32 "Application for a Certified Copy of Stillbirth Certificate" - Kentucky

What Is Form VS-32?

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

Form Details:

  • Released on January 3, 2020;
  • The latest edition provided by the Kentucky Department for Public 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 VS-32 by clicking the link below or browse more documents and templates provided by the Kentucky Department for Public Health.

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Download Form VS-32 "Application for a Certified Copy of Stillbirth Certificate" - Kentucky

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VS-32 Rev. 1.3.2020
COMMONWEALTH OF KENTUCKY
STATE REGISTRAR OF VITAL STATISTICS
STILLBIRTH
APPLICATION FOR A CERTIFIED COPY OF STILLBIRTH CERTIFICATE
PRINT
Limited numbers of stillbirths were reported prior to 1939
RESET
Please Print or Type Sections 1 through 13
STILLBIRTH CERTIFICATE INFORMATION
First
Middle
Last
1. Name of Child
Mother’s Name
Month
Day
Year
2. Date of Event
Kentucky City or Town
Kentucky County
Name of Hospital (if any)
3. Place of Death
First
Middle
Last
4. Attending
Physician’s Name
Name of Establishment
Phone Number
Address
5. Funeral Service
Provider
Relationship
6. What is your relationship to the person whose certificate is being
requested?
First
Last
7. Requestor’s Printed Name
Phone Number With Area Code
8. Requestor’s Phone Number
Street Address
9. Requestor’s Mailing Address
City, State, Zip
10. Requestor’s City, State, Zip
11. Requestor’s Signature
12. FEES – NON REFUNDABLE
DO NOT WRITE IN THIS SPACE
A fee is to be paid for certified copies or records or for a search of the files or records when
Volume
no record is available. The fee for a certified copy of a stillbirth certificate is $6.00 U.S.
Certificate
Additional copies are $6.00 U.S. each. Make check or money order payable to “Kentucky
State Treasurer.” This fee is non refundable.
Year
Date
________ Certified Copies @ $6.00 each = $
Searched by
How many
Total payment
Certificates may also be ordered by the following methods:
In Person: The Office of Vital Statistics is located at 275 East Main Street in Frankfort. Visit our lobby and complete an application for a certified copy of
a birth, death, marriage or divorce certificate from 8 a.m. to 3:30 p.m. Eastern Time Monday through Friday.
Internet: Certificates may be ordered on the internet using a credit card (Visa, MasterCard, Discover or American Express) or check. An additional
charge card fee will apply. This is in addition to the fee for each certified copy requested. Certificates requested via internet,
www.vitalchek.com/kentucky-
xpress-birth-certificates.aspx
may be delivered by overnight courier with payment of an additional shipment fee if that record is available.
Telephone: Orders may be placed by telephone using a credit card (Visa, MasterCard, Discover or American Express) or check. An additional processing
fee will apply. This processing fee is in addition to the fee for each certified copy requested. Certificates requested via telephone may be delivered by
overnight courier with payment of an additional fee. The telephone number to place your order is (800) 241-8322, choose option 1.
Mail: Orders are accepted by mail, using a check or money order in U.S. dollars drawn on a U.S. bank for payment. It can take up to 30 working days to
process your request from the date payment is posted. Mail application and payment to Vital Statistics, 275 East Main Street 1E-A, Frankfort, KY 40621.
The Office of Vital Statistics telephone number is (502) 564-4212.
Drop Box: The Office of Vital Statistics installed a drop box at the visitor entrance at 275 E. Main St., Frankfort for applications for certified copies
of birth, death, marriage and divorce certificates. Blank applications are provided on the drop box.
VS-32 Rev. 1.3.2020
COMMONWEALTH OF KENTUCKY
STATE REGISTRAR OF VITAL STATISTICS
STILLBIRTH
APPLICATION FOR A CERTIFIED COPY OF STILLBIRTH CERTIFICATE
PRINT
Limited numbers of stillbirths were reported prior to 1939
RESET
Please Print or Type Sections 1 through 13
STILLBIRTH CERTIFICATE INFORMATION
First
Middle
Last
1. Name of Child
Mother’s Name
Month
Day
Year
2. Date of Event
Kentucky City or Town
Kentucky County
Name of Hospital (if any)
3. Place of Death
First
Middle
Last
4. Attending
Physician’s Name
Name of Establishment
Phone Number
Address
5. Funeral Service
Provider
Relationship
6. What is your relationship to the person whose certificate is being
requested?
First
Last
7. Requestor’s Printed Name
Phone Number With Area Code
8. Requestor’s Phone Number
Street Address
9. Requestor’s Mailing Address
City, State, Zip
10. Requestor’s City, State, Zip
11. Requestor’s Signature
12. FEES – NON REFUNDABLE
DO NOT WRITE IN THIS SPACE
A fee is to be paid for certified copies or records or for a search of the files or records when
Volume
no record is available. The fee for a certified copy of a stillbirth certificate is $6.00 U.S.
Certificate
Additional copies are $6.00 U.S. each. Make check or money order payable to “Kentucky
State Treasurer.” This fee is non refundable.
Year
Date
________ Certified Copies @ $6.00 each = $
Searched by
How many
Total payment
Certificates may also be ordered by the following methods:
In Person: The Office of Vital Statistics is located at 275 East Main Street in Frankfort. Visit our lobby and complete an application for a certified copy of
a birth, death, marriage or divorce certificate from 8 a.m. to 3:30 p.m. Eastern Time Monday through Friday.
Internet: Certificates may be ordered on the internet using a credit card (Visa, MasterCard, Discover or American Express) or check. An additional
charge card fee will apply. This is in addition to the fee for each certified copy requested. Certificates requested via internet,
www.vitalchek.com/kentucky-
xpress-birth-certificates.aspx
may be delivered by overnight courier with payment of an additional shipment fee if that record is available.
Telephone: Orders may be placed by telephone using a credit card (Visa, MasterCard, Discover or American Express) or check. An additional processing
fee will apply. This processing fee is in addition to the fee for each certified copy requested. Certificates requested via telephone may be delivered by
overnight courier with payment of an additional fee. The telephone number to place your order is (800) 241-8322, choose option 1.
Mail: Orders are accepted by mail, using a check or money order in U.S. dollars drawn on a U.S. bank for payment. It can take up to 30 working days to
process your request from the date payment is posted. Mail application and payment to Vital Statistics, 275 East Main Street 1E-A, Frankfort, KY 40621.
The Office of Vital Statistics telephone number is (502) 564-4212.
Drop Box: The Office of Vital Statistics installed a drop box at the visitor entrance at 275 E. Main St., Frankfort for applications for certified copies
of birth, death, marriage and divorce certificates. Blank applications are provided on the drop box.