Birth Certificate Online Order Form

Instructions for Birth Certificate Order Form

Carefully read these instructions before completing and submitting the Birth Certificate Order Form. Chapter 70.58A RCW and Chapter 246-491 WAC requires all applicants to be a qualified applicant, provide identity and proof of eligibility documentation, and provide required information to order a birth certificate.

Checklist for completing the Birth Certificate Order Form:
• Complete all fields on the birth certificate order form, sign, and date
• A copy of your identity document(s)
• A copy of your proof of eligibility document(s)
• Online payment by debit/credit card

What is a qualified applicant?
A qualified applicant is a person who is eligible to receive a certificate.

Who are the qualified applicants for a birth certificate?
Qualified applicants for a birth certificate are: Self, Spouse/Domestic Partner, Child, Parent, Stepparent, Stepchild, Sibling, Grandparent, Grandchild, Great Grandparent, Legal Guardian, Legal Representative, Authorized Representative, or Government Agency or the Courts (only for official duties).

Are you one of the qualified applicants listed above to the birth certificate you are requesting?
If yes, continue. You will need to provide identity and proof of eligibility documentation.

**If you are not one of the listed above, STOP. You will not receive a WA State birth certificate**

What is proof of eligibility documentation?
Proof of eligibility documentation are documents that link you to the requested birth certificate.
1. If you are listed on the record and your identity documentation sufficiently links you to the record

(i.e. self or parents), your proof of eligibility requirement is met.
2. If you are not listed on the record or your identity documentation doesn’t sufficiently link you to the record, you must provide additional documentation to prove eligibility.

What documents will Public Health & Social Services (PHSS) accept to prove eligibility?
PHSS will accept the following documents to prove eligibility:
• Copies of vital records such as certifications of birth, death, marriage, and divorce from this or

another jurisdiction that link you to the requested record
• Copies of certified court orders from a court of competent jurisdiction linking you to the record (i.e. legal guardian)
• Document or letter from a government agency or courts stating the certification will be used in the conduct of official duties (for government and court officials only)

What identity documentation will PHSS accept?
PHSS will accept a copy of:
• One government issued identity document (must contain photo, full name, and date of birth) that is current or expired less than 60 days; or
• If you do not have a government issued identity document, then at least two alternate documents

from the alternate list.The alternate documents must contain matching first and last names and

addresses, or in combination contains full name,date of birth, and photograph.

What information is required?
The following information is required as it appears on the birth certificate:
• First and last name of the subject of record
• First and last name of all parents listed on the record
• Date of birth (mm/dd/yyyy)
• City or county where the birth occurred

Requestor Information

NAME OF PERSON ORDERING CERTIFICATE(S):

Requestor First Name *

Requestor Last Name *

Mailing Address *

City *

State *

Zip Code *

Daytime Phone Number *

Email Address *

To receive a birth certificate, you must indicate your relationship to the registrant below and sign the sworn statement that you are authorized to receive the certificate.

Select Relationship

Select Relationship *

Birth Records Details

NEWBORN BIRTH CERTIFICATES: Please wait 2 weeks from the date of birth to order the birth certificate. Hospital birth filings must be uploaded to the state database. Any orders received that are not in the state database will be returned to the applicant.

FIRST NAME ON CERTIFICATE *

FULL MIDDLE NAME ON CERTIFICATE

LAST NAME ON CERTIFICATE *

DATE OF BIRTH (mm/dd/yyyy) * +

CITY OF BIRTH *

COUNTY OF BIRTH

MOTHER/PARENT FIRST NAME *

MOTHER/PARENT MIDDLE NAME

MOTHER/PARENT MAIDEN LAST NAME *

FATHER/PARENT FIRST NAME

FATHER/PARENT MIDDLE NAME

FATHER/PARENT LAST NAME

Required Documentation

Proof of Identity *

I have uploaded a copy of my Identity document (ONE government issued identity document which must contain photo, full name, and date of birth, that is current or expired less than 60 days.)

Proof of Identity attachments *

Proof of Eligibility

I have uploaded my proof of eligibility documentation that links me to the requested birth certificate. If your name is on the record you are requesting (self or parent), your proof of eligibility has been met. If you are not listed on the record, you must provide additional documentation to prove eligibility.

View the Proof of Eligibility (422-178)(PDF) for examples of how to prove qualifying relationship
En Español (DOH 422-178)

Proof of Eligibility attachments

Certification *

By signing this form, I declare under penalty of perjury under the laws of the state of Washington that the information I have provided is true and correct. Further, be advised that willfully providing a false statement to vital records for a certificate is a gross misdemeanor under Washington law, RCW 70.58A.590(2).

Signature *

clear

Order Information

Birth Certificates cost $25.00 each

Online orders process and ship via standard United States Postal Service mail within 3-7 business days after we receive full payment and all required documentation. Missing information or documentation will delay orders.

Fee for debit/credit card transactions is $2.00 or 2.35% (whichever is greater)

SELECT THE TOTAL
NUMBER OF CERTIFIED
BIRTH CERTIFICATE
COPIES *

Current Total:

$0.00

Payment

Fee for debit/credit card transactions is $2.00 or 2.35% (whichever is greater)

Credit Card Type

Name on Card *

Credit Card Number *

Expiration Date *

CVV *

Office Use Only

Authorization #

Today's Date * +

Order Status