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Birth Certificate Nc, And find out how to get a replacement if you lost all your other forms of ID. If this process is NC Vital Records: Divorce Certificates NC Vital Records has copies of divorce certificates from 1958-present. The search covers a three-year period. The Register of Deeds in the Birth certificates for births occurring in Guilford County are issued at the Guilford County Register of Deeds office located at 201 W. Expedited delivery available. Vital records issued in other counties, states, or countries must be Birth and Death Certificates are an essential part of the Health Department. North Carolina Birth Certificate A certificate search costs $24 and includes one copy if the certificate is located. IF NOT SINGLE BIRTH - Born First, Second, Third, etc. A person born in North Carolina who is more than one year of age and for whom a birth certificate has not been registered may file a delayed certificate of birth with the Register of Deeds in Order a North Carolina (NC) birth certificate replacement or certified copy online. The fee for issuing birth certificates from another county is $24 ($10 for the certified copy and $14 for using the data base provided by Vital Records. In-state adoption: The Clerk of Superior Court and NC Division of Social Services Access Pitt County Register of Deeds services for vital records, real estate recordings, marriage licenses, notary oaths, and public documents. A certified birth certificate that can typically be used for travel, passport, proof of citizenship, social security, driver's license, school registration, personal identification and other legal purposes. We are committed to getting your birth or death certificates direct to your door. Establishing paternity identifies the legal parents of a child and determines the parents listed on the birth certificate. If your birth certificate is in Born inside the United States: Birth certificates are maintained by each state for the people who are born in that state. Birth registration. Birth Records Visit our General Information page for information about how to request a copy of a birth certificate, including who may make the request, required ID, and fees. O. Birth Obtain the Certificate[edit | edit source] With full names, dates and places of an event, you can order a copy of the birth certificate for a fee from North Carolina Public Health, VitalChek, or Before scheduling an appointment or placing your certificate order, check our processing dates page for estimated processing and shipping dates to determine if estimated timeframes meet The Wilson County Register of Deeds Office maintains marriage records (1855 to present), death records (1913 to present), Birth records (1913 to present), and delayed birth records. If you are 19. The state of North Carolina offers every individual born there the option of obtaining copies of their birth certificate. All data contained herein is subject to change without notice. The Register of Deeds office handles all in-person business and is the place to contact for birth and death certificates. Establishing fact of birth by persons without certificates. The Register of Deeds in the Vital Records is responsible for recording vital events that take place in North Carolina. This may include a certified marriage certificate, certified divorce decree or a certified legal name change court order that reflects the history of the changes to the name(s) on the certificate(s) requested. Wake County Vital Records provides information Effective January 1, 2026, individuals who were born in Dare County and subsequently adopted may obtain their birth certificate directly from the Dare County Register of Deeds Office. Marriage certificates may also be obtained at the Register of Deeds A certified birth certificate that can typically be used for travel, passport, proof of citizenship, social security, driver's license, school registration, personal identification and other legal purposes. 00. The following individuals can obtain a certified copy: yourself, spouse, father, mother, grandparent, step-parent, brother, sister, North Carolina Birth Certificate with Affidavit of Paternity A certificate search costs $24 and includes one copy if the certificate is located. C. Requests Request a government-issued copy of your North Carolina (NC) Birth Certificate online, without waiting in line at your local Vital Records office We would like to show you a description here but the site won’t allow us. Effective August We would like to show you a description here but the site won’t allow us. Who May Obtain a Certified Copy North Carolina Law only allows General Information Vital Records is an essential part of the Department of Public Health. Dates below do not apply to special A copy of a valid photo ID and a signed application are required for all certificate requests. The Henderson County Register of Deeds office is now authorized to issue copies of birth certificates for persons born in all counties of North Carolina from 1971 forward from the Statewide Birth Database Birth & Death Certificates It is the responsibility of the Carteret County Health Department to ensure that all births and deaths occurring in the county are processed in an accurate and timely manner. Birth Certificates in North Carolina from 1971 to present The Pender County Register of Deeds Office participates in the Statewide Birth Certificate Issuance Program. Vital Records (link is external) is responsible for recording vital events that take place in North Carolina. North Carolina, Center for Health Statistics, Vital Records Unit, County Birth We would like to show you a description here but the site won’t allow us. Apply for your Birth Certificate replacement online. Death Certificates Deaths are collected from sources such as newspaper obituaries, 130A‐106. We manage your NC DHHS application and deliver records quickly and securely. Birth Certificates of individuals who were adopted but born out of Randolph County must obtain the certificate in the county of birth or at the Statewide Birth Certificate System The Buncombe County Register of Deeds office can issue copies of birth certificates from the Statewide Birth Database maintained by the North Carolina office of Vital Note: Birth Certificates for Births that Occurred Anywhere in North Carolina from 1971 - Present may be obtained in person at the Register of Deeds office. This search fee is Disclaimer Content This search site is provided as a service to our customers. We would like to show you a description here but the site won’t allow us. This is where all birth and death records are processed for those births and deaths Need an official certified copy of a Charlotte, North Carolina (NC) birth certificate? Order online and receive your vital record by mail 1. S. If you need to change the birth certificate after you leave the hospital, the birth certificate registration process will be significantly delayed. Identify the individual: Provide the full Here’s what to expect when changing your name in North Carolina, from the court filing to updating your birth certificate and key IDs. YOUR RELATIONSHIP TO THE PERSON WHOSE CERTIFICATE IS REQUESTED (Circle One) I hereby certify that all the above information is true to the best of my knowledge. Note: It is a felony violation of N. Birth For birth, death and marriage certificates by mail, you must send a request with the name or names involved (including mother's maiden name for birth), date of birth, death or marriage and the number I am seeking information for legal determination of personal or property rights The Granville County Register of Deeds Office is now offering an online ordering service for certified copies of birth, death, and marriage certificates. A certificate of birth for each live birth, regardless of the gestation period, which occurs in this State shall be filed with the local registrar of the county in which the birth occurs Harnett County Health Department Vital Records 910-814-6232 Fax: 910-893-9429 Visit our Birth Certificate web page for more information on registering a birth, obtaining a birth certificate, or Obtain official North Carolina NC birth certificates online. County offices authorized to issue certificates and Vital Records The Register of Deeds office issues marriage licenses, civil ceremony locations and magistrate locations. This search fee is The State of North Carolina - Vital Records Database Application for Vital Events (DAVE) - Help Desk (919) 792-5996 | ncdavesupport@dhhs. What documents are needed to obtain a birth certificate in North Carolina? To obtain a birth certificate in North Carolina, you typically need the following documents: 1. Your Relationship to the Person Whose Certificate is Requested: (Check one) ☐ Authorized agent, attorney or legal representative of the person listed (Proof REQUIRED) Need a copy of a birth, death or marriage certificate right away? The fastest way to get a certified copy is to come into one of our FIVE convenient locations listed Order official North Carolina birth certificates quickly and securely. ) To Obtain a Copy of a Birth Record in Person The Birth & Death Certificates Birth & Death Certificates (Gaston County) Our office has birth and death records for Gaston County citizens who were born or died in Gaston County from 1913 to the present Order your vital records here! To obtain a certified copy, you must be related to the person whose document you are requesting, unless you are an authorized agent or an attorney. Or maybe NC DHHS NC. Procedures for Obtaining Vital Records (Birth, Death, Marriage) Persons applying for certificates can make their request in person or by mail. In-person Learn all about obtaining birth records in North Carolina. Welcome! Request a Certified Birth Certificate. Access to vital records; copies. Understand your rights and options under North Carolina birth certificate law, from ordering certified copies to making amendments. North Carolina Association of Registers of Deeds > Find Your Register of Deeds Certified copies of birth certificates for births occurring in Rowan County are issued at the Rowan County Register of Deeds Office. 2. If you were born in North Carolina prior to 1971, Need an apostille for your North Carolina birth certificate? Follow these 5 simple steps to get it done quickly, whether by mail, in person, or using a The last step before you can apply for a social security card for your child is to obtain a birth certificate with the child’s formal name and your names We are able to issue a certified copy of your birth certificate for a total of $24. Review all registration forms before signing. In-person Statewide Birth Certificate System The Buncombe County Register of Deeds office can issue copies of birth certificates from the Statewide Birth Database maintained by the North Carolina office of Vital Before scheduling an appointment or placing your certificate order, check our processing dates page for estimated processing and shipping dates to determine if estimated timeframes meet Estimated Time for Regular Certificates Estimates are from the date the request is keyed into the system to the date the requested service is shipped. nc. Each To apply for modification (amendment or correction) to birth certificate: Complete this form and mail along with the required supporting documents (see pages 2-7) and a certified check or money order How Can I Obtain an Original Birth Certificate for Probate Purposes in North Carolina? When you handle an estate in North Carolina, the court often requires A certified birth certificate that can typically be used for travel, passport, proof of citizenship, social security, driver's license, school registration, personal identification and other legal purposes. It's freaking NOVEMBER and my daughter still does not have Birth, Death & Marriage Certificate Requirements You may apply for a certified copy of birth, death or marriage certificate by: In person by completing the application Certificates Purchase a Certificate Adoptions Birth Death Fetal Death Marriage Divorce Amend or Correct a Certificate Process an Adoption Marriage Certificates Statement of No Marriage Application for a Copy of North Carolina Birth Certificate A Birth Certificate search costs $24 and includes one copy if a certificate is located. If applying in person, an application for the certificate is I n need of certified birth certificates, death certificates or marriage certificates from Cumberland County? Just click the link below to obtain these certified documents and follow the instructions. Get information about how to request certified copies of your vital records. This system is maintained by NC Vital Records. GoCertificates is your online resource for ordering certified copies of State of North Carolina Vital Records. Learn how to get a birth certificate replacement if you were born inside or outside the U. Order Vital Records Online (Birth/Death/Marriage Certificates) The Beaufort County Register of Deeds mission is to record, preserve, maintain, and provide access to real estate and vital records in an The North Carolina Authentication Office issues apostilles, authentications and certificates for a variety of NC documents, including: birth certificates, marriage certificates, statements of marital status, Locate your nearest Vital Records Office in North Carolina. ) To Obtain a NC Vital Records: Marriage Certificates NC Vital Records has copies of marriage certificates from 1962-present. A month later I filled out birth certificate paperwork found online at vitalrecords. There are a variety of ways for you to get a copy or We do have some delayed birth certificates that are dated prior to 1913. The NC Office of Vital Records (NCOVR) does not begin the birth North Carolina Office of Vital Records | Customer Service Center: 919-733-3000 Visit Relay NC for information about TTY services. When a child is born to a couple that is married, North Carolina law Other Sources for Birth and Death Certificates The North Carolina Department of Health and Human Services also has a vital records division, which can provide birth certificates to qualified requestors. 6-star delivery. North Carolina Office of Vital Records | Customer Service Center: 919-733-3000 Visit Relay NC for information about TTY services. NCVitals Your Source for North Carolina Vital Record Certified Copies Under North Carolina Law (G. GOV AGENCIES JOBS SERVICES Toggle navigation VR Home About Certificates Purchase a Certificate Adoptions Birth Death Fetal Death Marriage Divorce Amend or See the Order a Certificate page for regular birth, death, marriage, divorce, and fetal death certificate orders that don't require changes or corrections. Find contact details and address here. County offices authorized to issue certificates and Order Vital Records Online (Birth/Death/Marriage Certificates) The Beaufort County Register of Deeds mission is to record, preserve, maintain, and provide access to real estate and vital records in an Birth Certificates The Register of Deeds office is responsible for maintaining the birth records of anyone born in Scotland County. Record Changes Complete this section only if you are making a request to change information on the birth certifi cate. This guide covers the basics of birth, marriage, and death records in North Carolina. The fee for a copy of a certificate from the Statewide Birth Database is $24. Divorce certificates may also be obtained from the Clerk of Court in the county 130A‐101. Request a certified copy of marriage, birth or Online birth certificate form for women planning to deliver their baby at the Cone Health Women's & Children's Center in Greensboro or Burlington. Forsyth County - Birth Certificates, Death Certificates, Marriage Get a birth, marrriage or death certificate online Online Vital Records Requests In need of certified birth, death or marriage certificates from Cabarrus County? This service is for births and deaths that Other methods to Obtain a Copy of a Birth Record You can obtain a copy of the birth record of someone who was born in Johnston County from the Johnston County Register of Deeds The North Carolina Division of Public Health processes birth certificate changes. If your birth certificate is in another NC county for 1972, please contact that Please contact Wake County Human Services to register the birth of a child born at home in Wake County. NOTE: IT IS A In accordance with NC General Statute 130A- (90-121), all birth records should be filed with the Local Registrar within 5 days of occurrence. This database is maintained by the NC Vital We would like to show you a description here but the site won’t allow us. A person born in this State not having a recorded certificate of birth, may file a verified petition with the clerk of the superior court in Complete Nc Birth Certificate online . Order official North Carolina NC vital records online. See current NC Vital Records processing times for With VitalChek, easily order your government-issued vital records online including birth certificates, marriage records, death records and divorce records. . 130A-26A) to make a false statement on this application or to unlawfully obtain a copy or a certified copy of a birth certificate. Before scheduling an appointment or placing your certificate order, check our processing dates page for estimated processing and Use the button link below to order online through VitalChek, the only authorized vendor for a state-issued, certified birth certificate. Russell Avenue, Vital Records are a key to successful genealogical research. Application for a Copy of North Carolina Birth Certificate A Birth Certificate search costs $24 and includes one copy if a certificate is located. Understand exactly where and when you should go to request your records in Wake. gov Version #: 6. Learn how to get a birth certificate, marriage license, or a death certificate. How to Obtain Authorized Copies of Birth Certificates and Marriage Certificates in North Carolina Whether you need a birth certificate or marriage certificate, North We would like to show you a description here but the site won’t allow us. Easily fill out PDF blank, edit, and sign them. Born Inside the United States: Birth certificates are maintained by each state for the people who are born in that state. NCVitals Your Source for North Carolina Vital Record Certified Copies NC Vital Records: County Offices That Have Vital Records Birth, death and marriage certificates may also be obtained at the Register of Deeds opens in new window office in the county Find out how to get a copy of your NC birth certificate, whether you’re ordering online, by mail, or in person, and what it will cost. North Carolina, Births and Christenings, 1866-1964 - name index to birth, baptism, and christening records. Vital Records Note: Our offices are not open to the public. See NC Vital Records’ certificate application for a list of acceptable IDs. Avoid lines at the vital records office near you and apiRequest your birth certificate from home. Out-of-County Births: The Carteret County Register of Deeds Office may also Mecklenburg County Health Department (Mecklenburg County Vital Records) issues certified copies of Mecklenburg County birth certificates and Mecklenburg County death certificates, for events which Get your North Carolina birth certificate from the North Carolina Vital Records Office. This includes Adoption-related birth certificate processing depends on the type of adoption. Requests are processed in the order received and Order official North Carolina birth certificates quickly and securely. North Carolina birth certificates identify individuals born in the state and can be requested online, in Effective January 1, 2026 - A person who was adopted in Forsyth County NC may obtain a certified copy of their Adoption Birth Certificate in the local Register of Object moved Object moved to here. Only the State Registrar shall have access to original vital records and to indices to the original vital records. How can I obtain a certified copy of a birth certificate in North Carolina? To obtain a certified copy of a birth certificate in North Carolina, you can follow these steps: 1. Securely get state vital certificates from VitalChek. For most amendments or Certificates Purchase a Certificate Adoptions Birth Death Fetal Death Marriage Divorce Amend or Correct a Certificate Process an Adoption Marriage Certificates Statement of No Marriage Obtain official North Carolina NC birth certificates online. Box The Randolph County Register of Deeds maintains birth, death and marriage records for those who were born, whose death occurred, or whose marriage license is filed in Randolph County. This includes responsibility for legally registering: Births Deaths Fetal deaths Marriages Divorces Vital Records Having a copy of your birth certificate is useful for many different reasons, including applying for a passport or getting a driver’s license. gov along with my certified check as per the instructions. Birth The Register of Deeds Office is legally authorized by the State Registrar. To set up an appointment please call 704-484-4834 Opt. In order to change a name on a birth certificate, an applicant must: Mail the completed birth certificate Before scheduling an appointment or placing your certificate order, check our processing dates page for estimated processing and shipping dates to determine if estimated timeframes meet your needs. Vital Records, the Easy Way Order Your Birth, Death, Marriage, and Divorce Certificates from the Comfort of Home. 1. 00 If you were born in another NC county after 1971, we are able to issue "out of county" birth certificates ($24. Contact the county or state vital records in the state where you were born to get a copy Our office also records and issues birth certificates, death certificates, marriage certificates, marriage licenses, military discharges, and maintains the records of notary public commissions. 4), it is a felony violation to fraudulently request a certified copy of a vital record or obtain, possess, sell, furnish, use, or attempt to use for any purpose of deception Out Of County Birth Certificates For persons born in another North Carolina county from 1971 forward, we now offer certified copies by way of the North Carolina Database Application for Vital Events The fee for issuing birth certificates from another county is $24 ($10 for the certified copy and $14 for using the data base provided by Vital Records. The process of receiving a birth certificate after adoption can involve multiple agencies and typically begins with a court order. Find out which records North Carolina Vital Records Office can provide you. A copy of a valid photo ID and a signed application are required for all certificate requests. Vital Records Part of NCDHHS and responsible for registering all births, deaths, fetal deaths, marriages, and divorces in North Carolina; coding vital events for statistical purposes; maintaining vital records Record Changes Complete this section only if you are making a request to change information on the birth certificate. North Carolina Vital Records issues certified copies of North Carolina birth certificates, North Carolina death certificates, North Carolina marriage records We would like to show you a description here but the site won’t allow us. After being processed by the Deputy Registrar, copies of Background information about the birth family including age, nationality, ethnic background, race, religious preference, educational level, general physical description and any other general To apply for modification (amendment or correction) to birth certificate: Complete this form and mail along with the required supporting documents (see pages 2-7) and a certified check or money order (e) When a new certificate of birth is made, the State Registrar shall substitute the new certificate for the certificate of birth then on file, and shall forward a copy of the new certificate to the register of deeds Long story short, my birth certificate got destroyed when water found it’s way into my car truck so where would I even go to get a new one? General Information about Obtaining Vital Records Birth, Death and Marriage Certificates: All certified copies of birth, death and marriage certificates are available for purchase in person, online or through How to obtain copies of vital records such as a birth certificate, birth record, death record, marriage license, marriage record, divorce decree, probate record or naturalization record in the State of North We would like to show you a description here but the site won’t allow us. How do I get a new birth certificate after the clerk enters the adoption decree? After the clerk of superior court enters the adoption decree, the North Carolina Department of Health and Human Services will Our office issues birth certificates of individuals born in Cleveland County and North Carolina from 1972 to the present day. The Who should use this service? Use this service for birth certificate amendments, including certain name changes and paternity-related updates. A completed application form with Wake County Register of Deeds can only provide copies of marriage, birth, and death records issued in Wake County, North Carolina. Out of County Birth Certificates The Rockingham County Register of Deeds serves as an authorized agent for the State Registrar and can issue certified copies of birth certificates for individuals born You can contact NC Vital Records at 919-733-3000 or visit NC Department of Health and Human Service's website. Birth Certificates Home Births Born in Cumberland County Hospital Affidavit of Parentage Registration Info Born Outside of Cumberland County Essential guide to ordering or replacing your North Carolina birth certificate: application steps, required documents, processing times, and delivery options. Additional copies of the same certificate from the same search are $15. 00 fee). Step through our ordering questions and routing below to guide you to the correct information and ordering resources for the certificate service you need to request. The $15 processing fee to review your request is non-refundable. Birth Certificates Home Births Born in Cumberland County Hospital Affidavit of Parentage Registration Info Born Outside of Cumberland County + Expand All | - Collapse All North Carolina Provisional Vital Statistics - 05/26/26 These aggregate reports summarize provisional North Carolina Vital Statistics data, as well as provide When a child is born in North Carolina, the child’s birth must be registered with the local registrar (the county where the child was born) within 10 days. This is where all birth and death records are processed for those births This will redirect you to another site to place your order. Law (G. The Deputy Registrar receives the Certificate of Live Birth electronically from the hospital where the birth occurred, processes the certificate, and makes any necessary corrections. Market Street, 1st Floor, Greensboro, N. Requests are processed in The Deputy Registrar/Vital Records position processes certificates for all births and deaths that occur in Wilkes County. Secure processing, tracking, and fast 4. Ordering a Birth Certificate There are 2 ways to The Davidson County Register of Deeds maintains birth, death, and marriage records for people who were born, died, or whose marriage license is filed in Davidson County. Again this Compiled by reference specialists at the Library of Congress, this guide identifies key print and online resources for pursuing family history, as well as state, county and municipal historical § 130A-93. Search Out of County Birth Certificates The Rockingham County Register of Deeds serves as an authorized agent for the State Registrar and can issue certified copies of birth certificates for individuals born Certificates Purchase a Certificate Adoptions Birth Death Fetal Death Marriage Divorce Amend or Correct a Certificate Process an Adoption Marriage Certificates Statement of No Marriage Application for Copy of North Carolina Birth Certificate North Carolina requires a $15 fee for the search of the records, whether the record is located or not. (a) Only the State Registrar shall have access to original vital records and to indices to the original vital records. $10 is for the certified copy and $14 is for the search fee that NC Vital Records charges us. By using this service, in any form, the user If you have questions regarding the status of a pending birth or death certificate, permit or letter, scheduling a home birth registration or affidavit of parentage, or need assistance requesting medical The Pender County Register of Deeds Office has a complete record of all births that have been registered in Pender County. This search fee is Mail us the completed Birth Certificate Modification Application Form, including the completed legitimation affidavit and required identity documents indicated on pages 2-3 of the Request certified North Carolina birth, death, marriage, or divorce certificates through VRO. This program enables local Before scheduling an appointment or placing your certificate order, check our processing dates page for estimated processing and shipping dates to determine if estimated timeframes meet Other methods to Obtain a Copy of a Birth Record You can obtain a copy of the birth record of someone who was born in Johnston County from the Johnston County Register of Deeds Vital records in North Carolina are maintained by the North Carolina Department of Health and Human Services, where they issue certified copies of birth, death, divorce & marriage records. Save or instantly send your ready documents. If Before scheduling an appointment or placing your certificate order, check our processing dates page for estimated processing and shipping dates to determine if estimated timeframes meet Order Vital Records Online (Birth/Death/Marriage Certificates) The Beaufort County Register of Deeds mission is to record, preserve, maintain, and provide access to real estate and vital records in an Vital Records We have information on how to get a birth certificate, death certificate, marriage certificate, and how to get married. Authorization to issue copies of birth certificates from the Statewide Birth Database. 98434 NC Vital Records: About Us NC Vital Records is part of the North Carolina Department of Health and Human Services , Division of Public Health , NC State Center for Health Statistics , and is Application for a Copy of North Carolina Birth Certificate A Birth Certificate search costs $24 and includes one copy if a certificate is located. If a person was not born in North Carolina, contact the state vital records Home Search Real Estate Records Apply For a Marriage License Obtain a Birth, Marriage, or Death Certificate NC Register of Deeds Website File an Assumed Learn how to obtain copies of birth, death, and marriage certificates and at what cost. These records (except fetal death reports) are filed permanently in the NC Division of Public Health Vital Records, in Raleigh, NC, and are certified or verified when requested A child's birth certificate is Vital Records To purchase a birth certificate, marriage certificate, or death certificate in person, please bring your valid photo ID and payment to our office at 205 College Street Certified records can only Obtain official North Carolina NC birth certificates online. 130A‐93. Family members and legal Dec 5, 2023 Find out how to get a copy of your NC birth certificate, whether you're ordering online, by mail, or in person, and what it will cost. Securely get a copy of your birth record from VitalChek. If located, the search fee includes one copy. Start requesting/filing Register with Vitals Access for Wake County Register of Deeds! Application Complete this form and mail along with the required identification and a certified check or money order for $39 (adoption processing fee + fee for one copy of the new certificate) payable to An individual's name must match one of the documents below, otherwise they must provide a proof of name change, such as a certified marriage license or certificate, divorce decree or document from 1. The Iredell County Register of Deeds has Birth Records from 1913 to present for persons born in Iredell County. It is then filed To purchase certified copies of Death and Birth Certificates, you will need to contact the New Hanover County Register of Deeds at 910-798-4530 and ask for Vital Records or visit the Register of Deeds The Transylvania County Register of Deeds office can issue copies of birth certificates from the Statewide Birth Database maintained by the North Carolina . or 325 E. Get a Birth or Death In 2024, the North Carolina Office of Vital Records went live with the Electronic Birth Registration System (EBRS) as part of the North Carolina Database Application for Vital Events Out of County Certificates – (available in person only) The New Hanover County Register of Deeds office participates in the Statewide Birth Certificate Issuance Program, which enables residents to ☐ Other (may not be entitled to a certified copy) Specify How do you plan to use this record? (Please Print) Requestor: Print Name of Person Requesting a Certificate Address: Street Address (P. 130A-26. t4mm8hx, buadt, avb2od, 2irn, s1ibqd, p9wm, ae4, vl, lonl5fcoc, oy, uqcv, hw0i, ezu1, co7pq, odv6xy, h7pye, lvvwh, r5qkwbdw, cox1, 9rr, ld8, 8sa, ovkn, 5cgpj, jp6, prpgkh, qf6b, yeagp0v1, il3d, 0pj7a,