Filing Assistant Services

required fields ^*

STEP 1: Birth Certificate Order

What are you ordering? A Birth Certificate
Someone Else’s Birth Certificate YOUR Current Legal Name
(Person Filing - Include First Middle and Last)^* What State was the birth?^*

Confirm Current Legal Name

Legal First Name^*	Middle Name	Legal Last Name^*

Mailing Address (Where you would like the birth certificate to be delivered)^* APT, Suite, Floor, Etc. City^*

Zip/Postal Code^* Email Address^* Confirm Email Address^* Phone^* State Driver’s License # Has the person on the record ever changed his/her name through a marriage?^* Yes No

New Name Change After Marriage

New First Name^*	New Middle Name	New Last Name^*

State of Marriage Date of Marriage (mm/dd/year)

Purpose For Requesting The Record^*

What City was the birth?^*

What is the County of Birth?^*

What is your (person filing) Date of Birth?^*

What is your (person filing) Social Security Number?^*

Confirm Social Security Number?^*

What state was your Social Security Number issued?^*

What is your Drivers License Number?^* What state is your Drivers License from?^*

I Confirm this is MY Date of Birth & MY Social Security Number, not the person I’m filing for AND I confirm that I have reviewed the applicable state law and that I am eligible to apply for and receive the requested individual’s Birth Certificate.

Your information is 100% confidential, safe and secure.

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Birth Certificate Order

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