Application For Certified Copy Of Birth Record - County Of San Bernardino (Page 3 of 3) in pdf

Application For Certified Copy Of Birth Record - County Of San Bernardino Page 3

INSTRUCTIONS

A. If you are requesting an Authorized Certified Copy:

1. Complete the application form, one for each individual whose birth certificate you are requesting,

indicating on each how you are related to the individual (mark the appropriate box from the list).

NOTE: If the child is adopted, please make the request in the adopted name.

2. Complete the Sworn Statement

NOTE: Only one sworn statement is required if you are requesting multiple certificates at the same

time; however, the sworn statement must include the name of each individual whose birth certificate

you are requesting and your relationship to that individual.

a. Sign the Sworn Statement in front of a Notary Public and have it notarized

3. Submit $28.00 for each copy you request in the form of a personal check or money order (indicate the

number of copies you would like on the application form).

4. Send the completed application form, the notarized Sworn Statement and your payment to the

mailing address below.

B. If you are requesting a certified Informational Copy (if you do not qualify to receive an Authorized Certified

Copy, see application form):

1. Complete the application form, one for each individual whose birth certificate you are requesting.

NOTE: If the child is adopted, please make the request in the adopted name.

2. Submit $28.00 for each copy you request in the form of a personal check or money order (indicate the

number of copies you would like on the application form).

3. Send the completed application form and your payment to the mailing address listed below.

C. If you wish to submit your order in person at our physical address listed below, the Sworn Statement must

be signed in the presence of an Office of Vital Records staff member (it does not need to be notarized).

NOTE: If no record of the birth is found the $28.00 fee will be retained for searching (as required by

law) and a Certificate of No Record will be issued.

Checks payable to: “San Bernardino County”

Address:

Vital Statistics Section

340 N. Mountain View Ave

San Bernardino, CA 92415-0038

BIRTH

Rev. 01/2014

Application For Certified Copy Of Birth Record - County Of San Bernardino Page 3