INSTRUCTIONS FOR ONLINE USE: You may fill this form out online by clicking on a field below and
using your Tab key to advance to the next field. After entering your information you will need to print the
form, sign and date it, and mail it along with your fee to:
Division of Vital Records, Oklahoma State Department of Health
1000 Northeast 10th Street, Post Office Box 53551
Oklahoma City, Oklahoma 73152-3551
APPLICATION FOR SEARCH AND CERTIFIED COPY OF BIRTH CERTIFICATE
Facts Concerning This Birth
Full name of child _____________________________________________________________________________
Date of Birth _______________________
Place of birth ________________________________, OKLAHOMA
(Mo.)
(Day)
(Year)
(County)
(City)
Full name of father ____________________________________________________________________________
Full Maiden name of mother ____________________________________________________________________
Signature of person making this application _________________________
Date ______________________
If both parents names are not indicated on the original certificate of birth and a "full copy" is desired it will
be necessary to have the signature of the mother, or the registrant if of legal age, or if certificate is
required for "adoption purposes" the signature of the attorney of record and a statement from him to that
effect.
The above signature is by
( ) person himself-herself
( ) next-of-kin
( ) authorized agent
Purpose for which this copy is needed
( ) School
( ) Passport
( ) Employment
( ) Adoption
( ) Other ________________________
Please state
Has copy of this person’s birth certificate been received before?
( ) Yes
( ) No
( ) Unknown