REQUEST FOR CERTIFIED COPIES OF BIRTH

All copies issued by this office are certified copies with a “raised” seal.

Birth certificates are confidential records and available only to the person or parents (of the person named on that record. Additional documentation may be required of applicants stating they are an heir, legal guardian or legal representative of the person named on the record.

If you are requesting a birth certificate by mail, a copy of your current valid driver’s license or state issued ID as identification must accompany the request. If you are appearing in person, you are also required to show identification.

Current fees:

$10.00 — first certified copy of the record

$ 5.00 — additional certified copies (of the same record ordered at the same time) For example: 2 copies: $15.00; 3 copies: $20.00; 4 copies: $25.00, etc.

******Number of Copies Requested :

INFORMATION AS IT APPEARS ON THE BIRTH RECORD: (please print)

1. Full Name on Birth Record:

First Middle Last (Maiden)

2. Date of Birth:

3. Have you ever been Adopted? Yes No

4. Were you born in Iron County? Yes No

5. Place of Birth (City or Township):

6. Father’s Name:

7. Mother’s Full Maiden Name:

8. Are you named on the Birth Record? Yes No

I, the undersigned, affirm that I am in compliance with Michigan Statutes (M.C.L.A 333.2882) in requesting the above record.

*********Signature of Applicant

REQUEST MADE BY MAIL ONLY: Complete your return address below. Fees should be sent by check or money order payable to the Iron County Clerk. Enclose a clear photocopy of your current and valid driver’s license or state ID.

Mail to: Name:

Street Address:

City, State, ZIP:

Daytime Phone Number: