PAGE 1 OF 2 OFFICE OF VITAL RECORDS 0 3 / 2024
Birth Certificate Request
Use this form to order a birth certificate for a person born in Minnesota. If we cannot find the birth record you request, we
will send you a certified Statement of No Birth Record Found. NOTE: County offices generally provide the fastest vital
records service; in-person requests can often be fulfilled while you wait. It’s illegal to give false information to obtain a
vital record, and it may subject you to fines, jail time, or both. (Minnesota Statutes 144.227)
Information to find the requested birth record
Minnesota Rules 4601.2600
Child/Subject
Child/subject first name
Child/subject middle name
Child/subject last name
Date of birth (MM/DD/YYYY)
☐ Female
Minnesota city of birth
Minnesota county of birth
State of birth
MN
Parents
Parent one first name
Parent one middle name
Parent one last name
Last name before 1
st
marriage
Parent two first name
Parent two middle name
Parent two last name
Last name before 1
st
marriage
REQUIRED – Requester information
Minnesota Rules 4601.2600
Requester
Requester full name
Date of birth (MM/DD/YYYY)
Daytime phone (10-digit)
Requester street address
(Express delivery will not deliver to PO boxes or APO addresses.)
Apt/Unit #
Email
City
State
Zip code
REQUIRED — Mark the boxes that describe your relationship to the subject of the record
Minnesota Statutes 144.225
Marital status is important.
Records of children born to married parents are “public”. That means that the certificate is available to those listed in items 1 – 18
below. Records of children born to single mothers are “confidential” unless the mother chose to make the record public at the time of
birth. Only the persons listed below in items 19 – 23 may obtain confidential birth certificates.
“Public” birth records are available to individuals who meet any of the legal requirements in items 1-18
1.
☐
A parent named on the subject’s record
2.
☐
A grandparent of the subject
3.
☐
A great grandparent of the subject
4.
☐
A child of the subject
5.
☐
A grandchild of the subject
6.
☐
A great-grandchild of the subject
7.
☐
Spouse of the subject (You must be the current spouse)
8. ☐ I am the subject; I am requesting my own birth record
9.
☐ The legal custodian, guardian, or conservator of the subject (we need a certified copy of the court order that names you)
10.
☐ The health care agent for the subject (we need a valid “health care power of attorney” document)
11.
☐ Subject’s personal representative (we need a notarized statement that says you need the birth certificate to administer the estate)
12.
☐ Successor of the subject (subject is dead) (we need a notarized statement that says you need the birth certificate to administer the estate)
13.
☐
Proof that you need a birth certificate for the determination or protection of a personal or property right
14.
☐
Adoption agency — to complete post-adoption search (we need a copy of your Employee ID)
15.
☐
Local/state/tribal or federal governmental agency (we need a copy of your Employee ID) (Best practice: wait for family to verify record)
16.
☐
Attorney – I represent the subject, or a person listed in items 1-14 above.
My Minnesota Attorney License Number is:
If you are a NON-Minnesota attorney, attach a
copy of your attorney license.
17.
☐
Pursuant to a valid, certified copy of a U.S. court order (not a subpoena) releasing the certificate
18.
☐ I have a signed statement from a person above; it specifies the subject’s full name, date of birth, parents’ names, the signer’s
relationship to the subject of the record and it authorizes me to obtain the certificate.
“Confidential” birth records are available only under the conditions, or to the person, in items 19-23
19.
☐
Parent named on the subject’s record
20.
☐ The legal custodian, guardian, or conservator of the subject (you need a certified copy of a court order naming you)
21.
☐ The subject, when 16 years old or older
22.
☐ Representatives of Minnesota programs that administer child support, medical assistance, MinnesotaCare, and services under
Minnesota Statutes, sections 124D.23; Minnesota Statutes, chapter 260E; and, tribal child support programs, Minnesota
Statutes, section 144.225, subdivision 2, paragraph (f). (we need a copy of your Employee ID)
23.
☐
Pursuant to a valid, certified copy of a U.S. court order (not a subpoena) releasing the certificate
BIRTH CERTIFICATE REQUEST
PAGE 2 OF 2 OFFICE OF VITAL RECORDS 0 3 / 2024
Requester’s name:
REQUIRED – Sign this form in front of a notary public
Minnesota Rules 4601.2600
I certify that the information provided on this application is correct and complete to the best of my knowledge.
Requester’s signature (Signature must match the name of the requester on page one.)
Notary
Signed or attested before me on: day of , 20
Notary Stamp/Seal
Printed name of notary public
Notary public signature
My commission expires
Fees and records request
Fee
First birth certificate
$26 $26
Additional birth certificates # of extra copies
$19 each
Veteran’s Affairs (VA) birth certificate (for VA purposes only) # of copies
$0
Processing
Fee
Standard — request processed in the order received $0
Faster — request handled ahead of standard requests (doesn’t include express delivery)
$20
Shipping
Fee
Regular first-class mail $0
Express delivery (Check here
☐
to require a signature.)
$21
The Office of Vital Records and the express delivery service are not responsible for deliveries that do not require a
signature. Express delivery services will not deliver to PO boxes or APO addresses.
For delivery outside the United States, you must supply a prepaid express delivery envelope with your application.
Total due
Fees are due with the application and are non-refundable.
Payment method
☐ Credit card
MasterCard/VISA/Discover
Cardholder name
Valid thru
(MM/YY)
Card number
3-digit
code
☐ Check
Check #
Make check or money order payable to Minnesota
Department of Health. DO NOT SEND CASH. Checks returned
for non-payment will result in a $30 charge to you. You could
also face civil penalties.
☐ Money order
Money order#
Send your application and payment to:
Incomplete requests
Minnesota Department of Health
Office of Vital Records
Mail: PO Box 64499, St. Paul, MN 55164-0499
Fax: 866-416-1357 (credit card payments only)
Courier/express delivery: 625 Robert St. N, St. Paul, MN
55155 (no vital-records counter service at this location)
The Office of Vital Records returns applications that are
incomplete, not signed in front of a notary public, or not paid
in full at the time of application. (Minnesota Statutes 144.226;
Minnesota Rules 4601.2600) Unresolved requests will be
closed 12 months after we receive them. Once a request is
closed, customers must submit a new request and pay the fee
again to update the record and/or receive the vital records.
If you have questions, contact the Office of Vital Records at health.vitalrecords@state.mn.us or 651-201-5970.