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Birth and Death Certificates Home
Comments and Questions on a Newborn Birth Certificate

Directions: Please enter all the requested information into the available boxes. Once you have completed the appropriate sections, please click on the Submit button on the bottom of the page to send the information to our staff. If an item on the certificate is incorrect, please submit your comments here.

Vital Records Comment Form (Required):
Your Name:
Phone Number (Day):
Phone Number (Evening):
Your Street Address:
Zip Code:

Because staff may need to contact you with additional questions, it is important that you leave complete and accurate information regarding your name, address, telephone number, and email address.

If you would like additional information about a pending birth or death certificate order, please fill out the appropriate form.

Birth Certificate Comments
Name on Birth Certificate:
Date of birth:
Mother's maiden name:
Place of birth:
Your relationship to person on certificate:

Please check all that apply:

I have not received my child's birth certificate.
There is some other problem with the certificate I received.

NOTE: You will need to enable JavaScript in your browser in order to submit this form.

* Please enter the letters you see in the graphic below (required):
(letters are not case-sensitive)
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