Birth Certificate Order Form

Please use the application below to order a birth certificate from the Department of Health for births that occurred January 1, 2010 or LATER. For births that occurred BEFORE January 1, 2010, please click on the following link to the be transferred to and place your certificate order with the Vermont State Archives and Records Administration (VSARA).

Vermont Department of Health logo

 

Application for a Certified Copy of a Birth Certificate

For office use only

ID#
CPA#
REC#

Number of Copies:
Amount Enclosed $
Name on Birth Certificate:
Sex


Intended use of certificate

Date: _______________________________________

Signature: ______________________________________________________________