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            Vital Statistics - Washington County Health Department


PERSONS ELIGIBLE TO OBTAIN CERTIFIED COPIES OF BIRTH RECORDS

Person named on the record (over 18)

Parent (must be parent listed on birth certificate)

Grandparents (with proof of relationship)

Child (over 18) of person named on record (with proof of relationship)

Spouse (with proof of relationship)

Sibling (over 18, with proof and written release)

Court appointed legal guardian (must provide guardianship paper with seal)

Attorney representing person named on record (must have ID for self and ID/written release from person named on record)

Caseworker from Division of Family & Children with court appointed guardianship papers and ID)

Law enforcement personnel with ID and court order

 

A birth certificate may be released to other individuals when provided a written authorization, containing signature, birth information and ID of person named on the record, as well as the individual’s name the record is to released to.  The person the record is being issued to must also have ID.

 
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PLEASE MAIL THE COMPLETED APPLICATION REQUEST FORM (BELOW) AND A SELF ADDRESSED STAMPED ENVELOPE TO:
WASHINGTON COUNTY HEALTH DEPARTMENT
806 MARTINSBURG ROAD - SUITE 100
SALEM, IN  47167-5906
 (812) 883-5603


BIRTH CERTIFICATE APPLICATION FORM
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BIRTH CERTIFICATE MAY NOT BE OBTAINED BY:
*  AUNT OR UNCLE
*  COUSIN
*  BOYFRIEND OR GIRLFRIEND
*  FRIEND
*  DAY CARE PROVIDER

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IF YOU HAVE QUESTIONS, PLEASE CALL VITAL STATISTICS AT (812) 883-5603

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Copyright Washington County Health Department.