APPLICATION FOR AN APOSTILLED/AUTHENTICATED COPY— MICHIGAN BIRTH RECORD
Michigan Department of Health and Human Services
PART 1 – APPLICANT INFORMATION (PERSON FILLING OUT THIS FORM)
Applicant’s
First Name ____________________________ Middle ____________________ Last ______________________________
Mailing
A
ddress _____________________________________ City _____________________ State _______ Zip _____________
Daytime Phone w/ area code *R
equired ________________________ Email ____________________________________
PART 2 – RELATIONSHIP / INDICATE WHOSE BIRTH RECORD YOU ARE REQUESTING PER MCL 333.2882
□ Myself
□
My Child (If adopted, only adoptive parents are eligible)
□
I am the Legal Guardian, Custodial Party, or Power of Attorney (Copy of Court Order / Legal Documentation Required)
□ My Client (Licensed attorney must provide letter of representation with client name and State Bar # on official letterhead,
along with ID for both attorney and client. We do NOT accept delegations of authority or information releases.)
□ Heir of the Deceased (If not a Michigan death, must provide COPY of death certificate)
● Relationship to decedent _______________________________ ● State where death occurred _________________
● Decedent’s name at time of death ________________________________________ ● Year of death _____________
□ Birth Record is at least 100 years old (no ID required) □ Court of Competent Jurisdiction (Court Order & Fee Required)
PART 3 – BIRTH INFORMATION (TO LOCATE BIRTH RECORD ON FILE)
F
irst Name at Birth _________________________ Middle __________________ Last _____________________________
Date of Birth (mm/dd/year) _____/______/________ Place of Birth (City/County, State) _____________________________
Birth Parent/Mother’s Name ________________________ Birth Parent/Father’s Name _____________________________
Is the person named on the record Adopted?
□ Yes □ No Gender □ Male □ Female □ X
If yes,
Name AFTER Adoption First _____________________ Middle _______________ Last ______________________
Adoptive Parent/Mother’s Name _______________________ Adoptive Parent/Father’s Name _______________________
Did the name of the Applicant or the Person (Child) on the birth record change due to Marriage? □ Yes □ No
If yes, Place of Marriage (State) _____________________ Date of Marriage (mm/dd/year) _____/______/________
First _____________________ Middle _________________ Last ______________________
Did the Applicant or the Person (Child) on the birth record have a Court Ordered Legal Name Change? □ Yes □ No
If yes, Court Order Required First _____________________ Middle _________________ Last ______________________
PART 4 – COUNTRY OF USE REQUIRED
Apostille/Authentication is for use outside of the U.S.
PART 5 – PURPOSE OF REQUEST
PART 6 – APPLICANT SIGNATURE (PERSON FILLING OUT THIS FORM)
By signing, I understand I am agreeing to pay for a search of State of Michigan Vital Records. This does not guarantee that
a record will be found. Falsifying an application for a vital record and/or assuming the identity of another person is subject to
criminal penalties. Per MCL 333.2894(b) and 445.65.
Your Signature:
(Must be original in ink, by hand) ______________________________________________________ Date: _______________
PAYMENT AND COPY OF VALID IDENTIFICATION REQUIRED (SEE NEXT PAGE FOR DETAILS)
APPLICANT IDENTIFICATION REQUIREMENTS (SEND PHOTOCOPIES; ORIGINALS WILL NOT BE RETURNED)
TIER 1
One piece of documentation that establishes identity by itself.
● U.S. or Foreign Passport
● U.S. Passport Card
● U.S. or U.S. Territories Driver’s License or Identification Card
● U.S. Military Identification Card with both picture and signature
● Other U.S. or U.S. Territories issued document that meets the following criteria: Document must be unexpired, contain a
photograph and at least the following information: name, date of birth, date of expiration, signature, and address.
-OR- TIER 2
Must include all documentation listed in one of the following categories.
● Any of the documents in Tier 1 that expired within the past 5 years and any one document from Tier 3 issued within the past year
● Employment identification with photo, accompanied with a pay stub or W2 form issued within the past year
● Student identification with photo, accompanied by a current report card or other proof of current school enrollment. Both documents
must be for the same institution.
● Department of Corrections photo identification card accompanied by probation or discharge papers issued within the past year
● If an inmate is currently incarcerated: a Department of Corrections photo identification card accompanied by a verification of
incarceration on facility letterhead issued within the past year
-OR- TIER 3
Must include at least three (3) alternative documents from different sources from the list below; One must have been issued
within the past year.
● Any of the documents in Tier 1 expired more than 5 years
● Social Security Card (must be signed)
● Doctor/hospital/dentist bill
● Health insurance card
● Utility bill
● Voter registration
● Paycheck stub
● Bank statement
● Marriage or Divorce certificate
● Your child’s Birth certificate
● Motor vehicle registration
● IRS form W-2
● Baptismal certificate
● Military DD-214 discharge paper or equivalent
● School records
● Letter or benefit statement from a government agency
● Land or rental agreement
● Military ID with either a picture or signature.
● Other documents that establish identity to a degree equivalent
to those listed in this tier
PART 7 – PAYMENT Application Fee includes one Certified Copy or a No-Find Letter
Base Fee (Includes one year search) $42.00 $
Additional Years to Search
(If exact birth year is unknown)
Specify Years _____ _____ _____ _____ $12.00 per year $
Additional Apostilled Copies Specify Quantity ________ $26.00 each $
Expedited “Rush” Processing
Reduces in-office time.
(Does not affect mail time to/from our office)
$25.00 additional $
CHECK or MONEY ORDER made out to the “State of Michigan”
(Request will not be processed if payment is not included in envelope)
$
PROCESSING TIMES FOR MAILED REQUESTS WITH APOSTILLE / AUTHENTICATION
REGULAR SEARCH
Approximately 4 to 6 weeks of in-office processing at MDHHS, plus an additional 1 to 2 weeks at the Secretary of State’s
Office of the Great Seal. Then sent via regular mail. Completion time may vary, depending on volume of requests received.
EXPEDITED “RUSH” SEARCH
Approximately 2 to 3 weeks of in-office processing at MDHHS, plus an additional 1 to 2 weeks at the Secretary of State’s
Office of the Great Seal. Then sent via regular mail.
ADDITIONAL INFORMATION: Results are sent USPS First Class Mail, Pre-Paid envelopes will NOT be accepted
If you find that the above processing times do not meet your needs, please visit www.michigan.gov/vitalrecords or call our
Eligibility Unit at 517-335-8666 to speak with a customer service representative about available options.
MAIL APPLICATION (WITH PAYMENT AND REQUIRED DOCUMENTATION)
REGULAR MAIL TO:
Vital Records Requests
P.O. Box 30721
Lansing MI 48909
RUSH MAIL TO:
Vital Records RUSH
P.O. Box 30721
Lansing MI 48909
The Michigan Department of Health and Human Services (MDHHS) does not discriminate against any individual or group because of race, religion, age,
national origin, color, height, weight, marital status, genetic information, sex, sexual orientation, gender identity or expression, political belief, or disability.
DCH-0569
-BX-AUTH (Rev. 4-23) By Authority of MCL 333.2882(1)(a)(b) and MCL 333.2891(1-4) (8)