Birth Certificate Application Form - Nevada

This "Birth Certificate Application Form" is a Nevada-specific form released by the Nevada Department of Health and Human Services on January 31, 2013.

Download the form by clicking the link below, fill it out by hand, and mail it as per the guidelines provided by the department or the applicable legal instructions.

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State of Nevada Health Division
Bureau of Health Statistics Planning, Epidemiology and Response
Office of Vital Records and Statistics
4150 Technology Way, Suite 104
Carson City, Nevada 89706
Telephone (775) 684-4242
www.health.nv.gov/vs.htm
BIRTH CERTIFICATE APPLICATION
$20.00 for one certified copy
Number of copies____________
Or
$10.00 Search/Verification of a record (search/verifications do not include a certified copy. Choose this
option if you are only wanting verification that the record is on file with Nevada Office of Vital Records)
Check, or Money Order, made payable to Vital Records
______________________________________________________________________________
PHOTOCOPY OF APPLICANT’S ID /DRIVERS LICENSEAND
PAYMENT IN FULL IS REQUIRED TO OBTAIN CERTIFICATE
Full name at birth:
First
Middle
Last
Date of birth: _________________________________________________________________________
Place of birth: _________________________________________________________________________
Father’s name: _________________________________________________________________________
____________________________________________________________
Mother’s maiden name:
NRS 440.650 and NAC 440.070 require that a relationship or a need to facilitate a legal process be established in
order to receive a certified copy of a record.
Please state your relationship and your legal need for this record:____________________________________ 
_______________________________________________________________________________
Signature of applicant: __________________________________________________________________
Phone number: ________________________________________________
Your name and address (please print): _____________________________________________
_______________________________________________________________________________
FOR OFFICE USE ONLY
Amount received: _______________________ Receipt number: _________________________
No. of copies issued: ______________________ Date: ______________________
(Rev.01/31/2013) 
 
 
 
 
State of Nevada Health Division
Bureau of Health Statistics Planning, Epidemiology and Response
Office of Vital Records and Statistics
4150 Technology Way, Suite 104
Carson City, Nevada 89706
Telephone (775) 684-4242
www.health.nv.gov/vs.htm
BIRTH CERTIFICATE APPLICATION
$20.00 for one certified copy
Number of copies____________
Or
$10.00 Search/Verification of a record (search/verifications do not include a certified copy. Choose this
option if you are only wanting verification that the record is on file with Nevada Office of Vital Records)
Check, or Money Order, made payable to Vital Records
______________________________________________________________________________
PHOTOCOPY OF APPLICANT’S ID /DRIVERS LICENSEAND
PAYMENT IN FULL IS REQUIRED TO OBTAIN CERTIFICATE
Full name at birth:
First
Middle
Last
Date of birth: _________________________________________________________________________
Place of birth: _________________________________________________________________________
Father’s name: _________________________________________________________________________
____________________________________________________________
Mother’s maiden name:
NRS 440.650 and NAC 440.070 require that a relationship or a need to facilitate a legal process be established in
order to receive a certified copy of a record.
Please state your relationship and your legal need for this record:____________________________________ 
_______________________________________________________________________________
Signature of applicant: __________________________________________________________________
Phone number: ________________________________________________
Your name and address (please print): _____________________________________________
_______________________________________________________________________________
FOR OFFICE USE ONLY
Amount received: _______________________ Receipt number: _________________________
No. of copies issued: ______________________ Date: ______________________
(Rev.01/31/2013) 
 
 
 

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