Application For Certified Copy Of Birth Certificate
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1STATE OF WYOMING
Name as it appears on birth certificate
First Name __________________________________
APPLICATION FOR CERTIFIED COPY OF
BIRTH CERTIFICATE
Middle Name ________________________________
This request must be accompanied by a fee of $13.00 per
Last Name ___________________________________
copy. A money order or personalized check from the
person making the request should be made payable to
If this record could be recorded under any other name,
VITAL RECORDS SERVICES
list that name here
If you do not have a birth record on file, you will be sent
______________________________________
instructions for filing a Delayed Birth Certificate, and
your $13.00 fee will be retained as a searching fee.
Date of Birth
Sex
_____/_____/____
Male
Female
Enclosed is $________ for _____certified copy/copies
Place of Birth
_____________________, WY
Please enclose a self-addressed stamped envelope
with the application.
Mother’s Full Maiden Name
WARNING: Wyoming Statute 35-1-431 states that it
is a criminal violation to, willfully and knowingly, use
Full Name of Father
or attempt to use a birth certificate for any purpose
of deception.
Signature of Person Whose Certificate is Being
Requested or Parent Named on Certificate.
If under
Requests must include a photocopy of the driver’s
18 years of age, signature of parent or legal guardian
license, state issued ID card, or passport of the person
required. Legal guardian must submit a copy of guardianship
requesting the certificate. We will also accept a
papers.
notarized signature of the person making the request.
X___________________________________________
Address to Which Copy is to be Mailed
____________________________________
____________________________________
PHOTOCOPY OF IDENTIFICATION
____________________________________
Written signature must be a permanent
Part of ID
Mail your request to:
Vital Records Services
Hathaway Building
Cheyenne, WY 82002
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