Form Vs-37 - Application For A Certified Copy Of Birth Certificate
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1VS-37
(Rev 1/30/2012)
COMMONWEALTH OF KENTUCKY
STATE REGISTRAR OF VITAL STATISTICS
BIRTH
APPLICATION FOR A CERTIFIED COPY OF BIRTH CERTIFICATE
Certificates of Birth that occurred in Kentucky since 1911 are on file in this office
Please Print or Type All Information Required On This Form
BIRTH CERTIFICATE INFORMATION
First
Middle
Last
1. Full Name at Birth
Month
Day
Year
Sex
Age Last Birthday
2. Date of Birth
Kentucky City or Town
Kentucky County
Name of Hospital
3. Place of Birth
First
Middle
Last
4. Mother’s Maiden
Name
First
Middle
Last
5. Father’s Name
If this child has been adopted, please give original name if known:
DO NOT WRITE IN THIS SPACE
_____________________________________________________
Volume
Certificate
What is your relationship to the person whose certificate is being requested?
_____________________________________________________
Year
Date
Signature and telephone number of the person requesting this certificate:
Searched by
_____________________________________
___________________
Signature
Telephone
_____________________________________________________________________________________________________
Certificates may also be ordered by the following methods:
FEES
Internet: Certificates may be ordered on the internet using a credit card (Visa, MasterCard,
A fee is to be paid for certified copies or
Discover or American Express) or check. An additional charge card fee will apply.
records, or for a search of the files or records
This is in addition to the fee for each certified copy requested. Certificates requested via
when no copy is available. The fee for a
internet, , may be returned by
overnight courier for the cost of the additional shipment fee if that record is available.
certified copy of a birth certificate is $10.00
U.S. Additional copies are $10.00 U.S. each.
Telephone: Orders may be placed by telephone using a credit card (Visa, MasterCard,
Make check or money order payable to
Discover or American Express) or check. An additional charge card fee will apply. This is in
“Kentucky State Treasurer.” This fee is non
addition to the fee for each certified copy requested. Certificates requested via telephone may
be returned by overnight courier for the cost of the additional shipment fee. The telephone
refundable.
number to place your order is (800) 241-8322, choose option 1.
________ Certified Copies @ $10.00 each
Mail: Orders are accepted by mail, using a check or money order in U.S. dollars drawn on a
How many
U.S. bank for payment. It can take up to 30 working days to process your request from the
date payment is posted. Mail to Vital Statistics, 275 East Main Street 1E-A, Frankfort, KY
Total Amount Enclosed __________
40621. The Office of Vital Statistics telephone number is (502) 564-4212.
Walk-in: You may order a certified copy of the birth record by coming to this office. The
office is located at the address above. Orders are accepted for same day issuance from 8:00 AM
until 3:30 PM Monday through Friday.
______________________________________________________________________________________________________________________________
THIS SECTION MUST BE COMPLETE FOR ALL ORDERS
REQUESTORS INFORMATION:
__________________________
NAME
__________________________
MAILING ADDRESS
__________________________
__________________________
CITY, STATE, ZIP CODE
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