Birth Certificate Application - Montana

This Montana-specific "Birth Certificate Application" is a document released by the Montana Department of Public Health and Human Services.

Download the fillable PDF by clicking the link below and use it according to the applicable legal guidelines.

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INSTRUCTIONS FOR ORDERING A BIRTH RECORD
1. Print, Fill out completely, and Sign application. (see below for who can order)
2. Provide proof of Identity (see acceptable methods below)
3. Enclose cashier’s check or money order (see Fees below)
4. Enclose a stamped self-addressed return envelope.
(enclose a pre-paid envelope from express mail/UPS/FEDEX etc. for expedited
service. We do not track mail once it leaves our office - keep all tracking info)
5. Mail application, I.D., payment, and return envelope to Cascade County Clerk
th
and Recorder, 121 4
St N, Suite 1B1 Great Falls, MT 59401
WHO CAN ORDER A CERTIFIED BIRTH CERTIFICATE?
Only those authorized by 50-15-121 MCA, which includes the registrant (14 years old or older) the registrant’s spouse,
children, parents or guardian or an authorized representative, may obtain a certified copy of a birth record. Proof of
relationship, guardianship or authorization is required. Step-relatives, in-laws, grandparents, siblings, aunts, uncles, cousins,
ex-spouses, and a natural parent of an adoptive child or others are NOT eligible to receive a certified copy of a birth certificate.
Non-certified informational/genealogy copies are available to anyone if record is more than 30 years old.
Montana birth certificates are full size paper with a raised seal.
Wallet size cards are not available.
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 the application notarized.
•If a picture ID with a signature is not available, two other forms of identification are required; one MUST have a
signature.
•If you have no identification and an authorized family member cannot send an application for you, then you may
send a notarized Montana Office of Vital Statistics Statement to Identify form filled out by a witness who has
known you for more than 2 years who can attest to your identity. (see link on previous page to download this form
if needed)
SUGGESTED IDENTIFICATION
Picture ID
OR
OR
ANY TWO Forms of ID Listed Below (One MUST
with
have a signature)
Signature
Photocopy of:
OR Photocopies of 2 of the below- one with signature:
OR : Have the application Notarized
(original application only not faxed or
Driver’s License
Social Security Card
Fishing License
photocopied)
State ID Card
Pay Stub
Insurance Record
OR: Have someone who has known
Passport
US Military DD-214
Traffic/Pawn Ticket
you for more than 2 years fill out a
Tribal ID Card
Utility Bill with a current address
Doctor/Medical Record
Notarized Montana Office of Vital
Military ID Card
Court Record
Library Card
Statistics Statement to Identify
(w/ signature)
Voter Registration Card
Year Book
Certified Birth or Death Certificate
School ID Card
Credit/Debit/ATM Card
Applicant Form (original only, not a
Car Registration/Insurance
Work ID Card
photocopy or faxed copy) along with
the application filled out by you.
FEE: (All fees must be U.S. funds)
Money Order or Cashier’s Check Only, NO personal checks or cash accepted. Make payable to Cascade County Clerk and
Recorder , and make sure you sign it. (If you come into our office in person, cash is acceptable.) Credit/debit cards not accepted.
Certifed copies of a Birth Certificate:
Cost is $5.00
for each copy. (non-refundable) You do not need to send separate money orders for multiple requests in one
envelope.
Informational copies of a Birth Certificate:
Cost is $.50 each Not certified (for informational /genealogy purposes only and cannot be used for any legal purpose) may be
issued to anyone, as long as the birth occurred at least 30 years prior to the date of application. If you do not know the year of
birth we charge .50 cents per year to search for the record. (non-refundable)
MAIL : Most requests are processed within 2 working days of receipt. You may wish to send your request by an express mail
(eg. UPS, FEDEX, USPS EXPRESS), along with a pre-paid self addressed return express mail envelope to speed up the
mailing process. You are responsible for tracking your mail before we receive it and after it leaves our office. Certificates can
only be mailed to the authorized applicant. We do not guarantee any return times.
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 will occur.
INSTRUCTIONS FOR ORDERING A BIRTH RECORD
1. Print, Fill out completely, and Sign application. (see below for who can order)
2. Provide proof of Identity (see acceptable methods below)
3. Enclose cashier’s check or money order (see Fees below)
4. Enclose a stamped self-addressed return envelope.
(enclose a pre-paid envelope from express mail/UPS/FEDEX etc. for expedited
service. We do not track mail once it leaves our office - keep all tracking info)
5. Mail application, I.D., payment, and return envelope to Cascade County Clerk
th
and Recorder, 121 4
St N, Suite 1B1 Great Falls, MT 59401
WHO CAN ORDER A CERTIFIED BIRTH CERTIFICATE?
Only those authorized by 50-15-121 MCA, which includes the registrant (14 years old or older) the registrant’s spouse,
children, parents or guardian or an authorized representative, may obtain a certified copy of a birth record. Proof of
relationship, guardianship or authorization is required. Step-relatives, in-laws, grandparents, siblings, aunts, uncles, cousins,
ex-spouses, and a natural parent of an adoptive child or others are NOT eligible to receive a certified copy of a birth certificate.
Non-certified informational/genealogy copies are available to anyone if record is more than 30 years old.
Montana birth certificates are full size paper with a raised seal.
Wallet size cards are not available.
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 the application notarized.
•If a picture ID with a signature is not available, two other forms of identification are required; one MUST have a
signature.
•If you have no identification and an authorized family member cannot send an application for you, then you may
send a notarized Montana Office of Vital Statistics Statement to Identify form filled out by a witness who has
known you for more than 2 years who can attest to your identity. (see link on previous page to download this form
if needed)
SUGGESTED IDENTIFICATION
Picture ID
OR
OR
ANY TWO Forms of ID Listed Below (One MUST
with
have a signature)
Signature
Photocopy of:
OR Photocopies of 2 of the below- one with signature:
OR : Have the application Notarized
(original application only not faxed or
Driver’s License
Social Security Card
Fishing License
photocopied)
State ID Card
Pay Stub
Insurance Record
OR: Have someone who has known
Passport
US Military DD-214
Traffic/Pawn Ticket
you for more than 2 years fill out a
Tribal ID Card
Utility Bill with a current address
Doctor/Medical Record
Notarized Montana Office of Vital
Military ID Card
Court Record
Library Card
Statistics Statement to Identify
(w/ signature)
Voter Registration Card
Year Book
Certified Birth or Death Certificate
School ID Card
Credit/Debit/ATM Card
Applicant Form (original only, not a
Car Registration/Insurance
Work ID Card
photocopy or faxed copy) along with
the application filled out by you.
FEE: (All fees must be U.S. funds)
Money Order or Cashier’s Check Only, NO personal checks or cash accepted. Make payable to Cascade County Clerk and
Recorder , and make sure you sign it. (If you come into our office in person, cash is acceptable.) Credit/debit cards not accepted.
Certifed copies of a Birth Certificate:
Cost is $5.00
for each copy. (non-refundable) You do not need to send separate money orders for multiple requests in one
envelope.
Informational copies of a Birth Certificate:
Cost is $.50 each Not certified (for informational /genealogy purposes only and cannot be used for any legal purpose) may be
issued to anyone, as long as the birth occurred at least 30 years prior to the date of application. If you do not know the year of
birth we charge .50 cents per year to search for the record. (non-refundable)
MAIL : Most requests are processed within 2 working days of receipt. You may wish to send your request by an express mail
(eg. UPS, FEDEX, USPS EXPRESS), along with a pre-paid self addressed return express mail envelope to speed up the
mailing process. You are responsible for tracking your mail before we receive it and after it leaves our office. Certificates can
only be mailed to the authorized applicant. We do not guarantee any return times.
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 will occur.
MONTANA BIRTH CERTIFICATE APPLICATION
th
Cascade County Clerk & Recorder, 121 4
St N Ste 1B1, Great Falls MT 59401 406-454-6718
www.co.cascade.mt.us
IDENTIFICATION IS REQUIRED
Picture I.D. with signature or other acceptable proof of identity required. See instruction page.
COMPLETE THE FOLLOWING – PLEASE PRINT
PERSON WHO IS APPLYING FOR BIRTH CERTIFICATE
Your Name as shown on ID (
________________________________________
PRINT)
Your
Relationship to person on birth certificate (check one)
(__) Self (__) Parent of person (__) Spouse of person (__) Child of person (__) Guardian of person
(must send original documents as proof ) (__) Authorized representative (must send original documents
as proof) (__) Other __________________(if checked you cannot get a certified copy - see instructions)
Address
_____________________________________________________________________________
Daytime Phone no
. (______)__________________________
SIGNATURE x ______________________________________________________________
INFORMATION ON BIRTH CERTIFICATE
NAME OF PERSON ON BIRTH CERTIFICATE: (if adopted or name legally changed give new name)
____________________________________________________________________________________
First
Middle
Last (MAIDEN if female)
DATE OF BIRTH: Month__ __Day__ __Year __ __ __ __ PLACE ____________________________
(County or City in Montana where born)
FATHERS NAME: (or if adopted give the new name)
_____________________________________________________________________________________
First
Middle
Last
MOTHERS MAIDEN NAME: (or if adopted give the new name)
_____________________________________________________________________________________
First
Middle
Last MAIDEN (name before marriage)
Reason Birth Certificate is needed
____________________________________________________
( what are you using the birth certificate for?)
Number of Certified copies ___ @ $5.00 each
(No Personal Checks accepted)
Non-certified (informational/genealogy purposes only & must be more than 30 years old - cannot be used for any legal
purpose) __ @ .50 cents each (if year is unknown searches are .50 cents per year)
Optional - NOTARY BLOCK
(if needed - see instructions for proof of identity requirements)
___________________________________personally appeared before me and whose identity I proved on the basis of satisfactory evidence to be the
signer of the above instrument.
Subscribed and sworn to before me this _________day of ________________ 20______
Signature__________________________________________________
SEAL
Printed Name: _____________________________________________
Notary Public in and for the State of_____________________________
Residing at ___________________Commission Expires_____________
NOTICE: STATE LAW PROVIDES PENALTIES FOR
OFFICE USE ONLY – DO NOT WRITE IN THIS SPACE
PERSONS WHO WILLFULLY AND KNOWINGLY
Certificate #__________________________________
USE OR ATTEMPT TO USE OR FURNISH TO
Security paper #_________________________
ANOTHER FOR USE, FOR ANY PURPOSE OF
Date_________________________________
DECEPTION,ANY CERTIFICATE, RECORD, REPORT
I.D. Verified by__________________________
OR CERTIFIED COPY MADE, ALTERED, AMENDED
OR MUTILATED. (50-15-114(C), MCA)

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