Submit City of Birth: Please select the city and county of birth for the subject of the certificate. INFORMATION ABOUT THE SUBJECT OF THE CERTIFICATE Name of Subject: The name exactly as it appears on the certificate. Name of Mother: Please enter both the current last name of the mother and her maiden name. Name of Father: Enter “unknown” or “not named” if the father is unknown or was not listed on the birth certificate. Date of Birth & Social Security Number of the Requestor: This is an additional safeguard to protect your identity and the security of the requested certificate. INFORMATION ABOUT THE REQUESTOR IMPORTANT!: The requestor is the person ordering the certificate, not the person named on the certificate. If you are ordering your own certificate, you are both the requestor and the subject. The name of the credit card holder must be the same as the requestor. Delivery Address: If certificate is delivered by UPS shipping, it must be signed for at this address. Certificates delivered by UPS cannot be sent to a P.O. Box. ORDER INFORMATION *UPS to Alaska, Hawaii or Puerto Rico is $25.50. UPS to all international locations is $37.50. CREDIT CARD INFORMATION CERTIFIED COPY OF WASHINGTON BIRTH CERTIFICATE Date of Birth: The exact date of birth of the person listed on the certificate. / - - - Telephone & Email Address of the Requestor: You will be contacted if more information is required. - - - - 1. I agree and understand that the total fee is broken down into 2 payments. The initial fee of $52.87 per certificate will appear on your credit card as ‘U.S. Vital Records’ or ‘U.S. Vital Certificates’. The second fee will appear as ‘VCN Washington’. 2. I have read and agree to the Terms of Service. VERIFY REQUEST Enter your full name in the box below. Entering your name constitutes a signature and an agreement that you have read and agree to all the provisions contained below. It additionally affirms that all information provided on this order form is complete and accurate and that you are a person authorized to obtain a Washington Vital Certificate as indicated by your answer to Relationship to Subject. Type full name to represent your signature and acknowledge that the terms below have been accepted. Retype Email Address Alternate Telephone First Name Middle Name Current Last Name Month of Birth Day of Birth Year of Birth First Name Middle Name Current Last Name Maiden Last Name Suffix Gender Subject Still Living City of Birth County of Birth Month of Birth Day of Birth Year of Birth First Name of Mother Middle Name of Mother Current Last Name of Mother Maiden Last Name of Mother First Name of Father Middle Name of Father Last Name of Father Delivery Address Delivery Address Continued Town/City State/Province Country ZIP/Postal Code Daytime Telephone Select Number of Copies Select Delivery Method Credit Card Type Credit Card Security Code Full Name of Cardholder Cardholder Email Credit Card Number Credit Card Expiry Date Email Address TOTAL FEE WILL APPEAR AS 2 SEPARATE CHARGES ON YOUR CREDIT CARD. U.S. VITAL RECORDS or U.S. VITAL CERTIFICATES $52.87 (upon receipt of your application) & VCN Washington $50.00 for UPS Delivery OR $31.50 for Regular Mail (AFTER ID requirements are met). Washington Birth Certificate Order Form
Posted on: Sun, 12 Oct 2014 22:13:38 +0000
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