Application for a Birth Death Marriage or Divorce Certificate Alabama

Application for a Birth Death  Marriage or Divorce Certificate Alabama alabama birth certificate application pdf, alabama birth certificate online, printable alabama marriage certificate form, alabama birth certificate replacement, alabama vital records, vital statistics form for divorce, alabama marriage certificate form 101, alabama death certificate pdf,


USE ONLY FOR A VITAL EVENT WHICH OCCURRED IN ALABAMA The fee for a birth, death, marriage or divorce record search is $1 5 .00 , which includes the cost of one certified copy OR a C ertificate of Failure to Find. For additional copies of the same record ordered at the same time, the fee is $6 .00 each. Amendments, adoptions, legitimations, and delayed certificates must be processed through the Center for Health Statistics. The fee is $20.00 to amend a record or file a delayed certif icate which also covers the cost of one certified copy of the record. The fee is $25.00 to prepare a new certificate of birth after adoption or legitimation which also covers the cost of one certified copy of the record . Make check or money order payable to the "State Board of Health. ” D o not send cash . Fees are non -refundable . Do not request two different types of certificates on the same form. PRINT ALL INFORMATION LEGIBLY . You must complete & sign the applicant section or your request cannot be processed. TAKE THIS FORM TO YOUR LOCAL ALABAMA COUNTY HEALTH DEPARTMENT OR MAIL THIS FORM TO: Alabama Department of Public Health, Center for Health Statistics, P.O. Box 5625, Montgomery, Alabama 36103-5625. For inform ation on expediting a request or ordering onlin e, visit our website at http://www.alabamapublichealth.gov/vitalrecords or call 334 - 206 - 5418 . APPLICANT SECTION (THIS SECTION MUST BE COMPLETED) Birth certificates less than 125 years old and death certificates less than 25 years old are restricted records . Valid identification must be submitted with a r equest for a restricted record. You must be an immediate family member OR demonstrate a legal right to the record in order to obtain a copy of the record (§ 22- 9A -21) . Anyone falsely applying for a record is subject to a penalty upon conviction of up to three months in the c ounty jail or a fine of up to $500. Cod e of Ala. 1975, § 13A -10- 109. By signing, you are certifying you have a legal right to the record requested . Your Signature _______________________________________________________________ Date ____________________________________ Print Your Name ___________________________________________ Address __________________________ _________________________ City ________________________________ State ________ Zip __________________ Daytime Phone (_____)_____ ____________________ Your Relationship to Person Whose Record is Being Requested __________________ _________________________________________________ Reason for Request (if not immediate family) _________________________________________ ________________________________________ I allow the following individual to receive certificate(s) ____________________________________ ______________________________________ _ BIRTH: SEE ID REQUIREMENT S ON REVERSE SIDE NUMBER OF COPIES ______________ _ AMOUNT PAID $ ______________ _ _ _ FULL NAME AS ON BIRTH CERTIFICATE ______________________________________________________________________________ _____________________ FIRS T MIDDLE LAST DATE OF BIRTH ____________________________ _________________________________________ SEX _____________________ _ COUNTY OF BIRTH _____________________________________________ HOSPITAL ___________________________________________ _____ FULL NAME OF MOTHER/ PARENT BEFORE FIRST MARRIAGE ______________ ____________________________________________________________________________ FIRST MIDDLE LAST FULL NAME OF FATHER/ PARENT BEFORE FIRST MARRIAGE ________________________________________________________________________________________ __ FIRST MIDDLE LAST DEATH: SEE ID REQUIREMENT S ON REVERSE SIDE NUMBER OF COPIES _____ ___ ______ _ AMOUNT PAID $ _____________ _ __ _ LEGAL NAME OF DECEASED ____________________________________________________________________________________________ _ FIRST MIDDLE LAST DATE OF DEATH ______________________________ COUNTY OF DEATH _____________________________ SEX ______________________ SSN ___________________________________ DATE OF BIRTH OR AGE ____________________________ RACE ________________________ NAME OF SPOUSE ____________________________________________________________________________________________________ FIRST MIDDLE LAST NAME OF PARENTS __________________________________________________________________________________________________ STARTING WITH 1991 DEATHS, CERTIFICATES MAY BE ISSUED WITHOUT A CAUSE OF DEATH. Indicate the number of copies of each type of certificate you want: WITH CAUSE OF DEATH WITHOUT CAUSE OF DEATH ___ MARRIAGE OR ___ DIVORCE: NUMBER OF COPIES _______________ AMOUNT PAID $ __ __ ____________ _ FULL NAME OF HUSBAND/SPOUSE BEFORE FIRST MARRIAGE _____________________________________________________________________________________________ _ FIRST MIDDLE LAST FULL NAME OF WIFE/SPOUSE BEFORE FIRST MARRIAGE _____________________________________________________________________________________________ _ FIRST MIDDLE LAST IF MARRIAGE, DATE OF MARRIAGE ___________________________ COUNTY WHERE LICENSE WAS ISSUED _________ ________________ ______ _ IF DIVORCE, DATE OF DIVORCE _____________________________ COUNTY OF DIVORCE _________________________ ______ ____________ _ COUNTY REGISTRAR USE: This application has been reviewed for the individual's right to receive the requested document(s). __________________________________________________________________ ____________________ _________________________________________________ ________ __ County Registrar's Signature Date County Health Department Receipt Number Informational materials in alternative formats will be made available upon request. ADPH -HS14/Rev. 3/2018 IDENTIFICATION REQUIREMENTS FOR RESTRICTED ALABAMA VITAL RECORDS Identification is required of any applicant requesting a restricted Alabama vital record (birth certificate less than 125 years from the date of birth or death certificate less than 25 years from the date of death). The a pplicant must submit a completed request and one form of identification from the Primary ID list below. In the event the applicant is unable to provide identification from the Primary ID list, he/she may provide two different forms of identification from the Secondary ID list. If the applicant designates another individual to pick up a restricted certificate on his/her behalf, both the applicant and the designee must provide acceptable identification. The completed request , as well as a copy of all identification submitted, will be maintained by the vital records office which processes the request . Primary IDs Including PHOTO (need at least one, current, expired no more than 60 days) Secondary IDs (need at least tw o) - Alabama Driver’s License - Out -of-State Driver’s License - State -Issued Non -Driver ID - U.S. or Foreign Passport - U.S. Certificate of Naturalization - Certificate of Citizenship - U.S. Military ID - Work ID (If applicant is employee of agency/company making request) - Alien Resident Card (Temporary or Permanent) - U.S. Employment Authorization Card - Citizenship ID Card - Tribal ID - Pilot’s License - Boating License - Concealed Weapons License - Ex-Felon ID - Inm ate ID issued by the U.S. Dept of Justice w/ following documentation: o Supporting documents from institution if inmate is still in custody, letter of release from institution if inmate has been released - School ID (Must include current school term) - Alabama V oter Identification Card - Expired, Government -Issued ID - Utility Bill (No more than 6 months old) - Work ID (If applicant is making personal request) - Vehicle Registration or Vehicle Title - Property Tax Bill - Military Discharge (DD Form 214) - Voter Registration Card - Health Insurance Card - Social Security Correspondence (not Card) - U.S. Selective Service Card - Recent DMV Receipt for Fines Paid - Fishing or Hunting License - Copy of Police Report or other official documents which support theft, in cases where individual’ s ID has been stolen - Autism Spectrum Card - Immunization (Shot) Record * In special cases where applicant is unable to provide any of these documents, please contact CHS at 334.206.5418.


Certificate TypeBirth, Death, Marriage, or Divorce Certificate
Issuing AuthorityAlabama Department of Public Health or relevant county health department (for vital records)
PurposeTo obtain certified copies of vital records for various legal and personal purposes
Document TypeOfficial Government Certificate
FormatTypically available as downloadable PDF forms for application or obtainable in person
AvailabilityAlabama Department of Public Health website or local county health departments
Application Forms- Alabama Vital Records Request Form for Birth and Death Certificates<br>- Marriage and Divorce Certificate applications vary by county
RequirementsAccess to a PDF reader for online forms or in-person visit for physical forms
Accessible DevicesComputers, smartphones, tablets, and other devices with PDF reader apps
Application Process- Complete the relevant application form with required information<br>- Provide proof of eligibility to access the record (e.g., for birth certificates, you may need to be an immediate family member)
Submission- Mail or submit the completed form and required documents to the Alabama Department of Public Health or the appropriate county health department<br>- Some counties may offer online application and payment options
Fees- Fees for obtaining certified copies vary by certificate type and county<br>- Fees may also depend on whether you request a certified or non-certified copy
Official WebsiteAlabama Department of Public Health - Vital Records
Application PDF

Application for a Birth Death  Marriage or Divorce Certificate Alabama alabama birth certificate application pdf, alabama birth certificate online, printable alabama marriage certificate form, alabama birth certificate replacement, alabama vital records, vital statistics form for divorce, alabama marriage certificate form 101, alabama death certificate pdf,