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

Birth Facts

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 persons birth certificate been received before? (   ) Yes (   ) No (   )Unknown


PLEASE PRINT CORRECT MAILING ADDRESS BELOW:
Mailing Address


Request for a search of the records for a birth certificate of any person born in Oklahoma should be submitted on this form along with the required fee of $5.00 If the birth record is on file, a certified copy will be mailed. If no record of the birth is found, then blanks and instructions for filing a "delayed" birth certificate will be sent. This fee will be credited on the $10.00 fee required for the first ceritified copy from the delayed record after it has been placed on file.

The information requested above should be filled in carefully and accurately. It is the minimum needed in the Vital Records office to make a thorough search for any birth record.

Send five dollars ($5.00) in cash, money order or check for each copy desired. Cash is sent at sender's risk. Make checks or money orders payable to the State Department of Health.

A copy required to be submitted to the Veterans Administration or U.S. Commissioner of Pensions, in connection with a claim for military-service-connected benefits may be obtained without fee provided a signed statement is attached which sets forth these facts and requests that the copy be issued without fee. Members of the armed forces and veterans must pay regular fees for copies to be used for all other purposes.

VS 151 R8-91



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