
DENVER HEALTH
Denver Vital Records
605 Bannock St. Room 302
Denver, Colorado 80204-4507
303- 602-3660
www.denverhealth.org/vitalrecords
Application for Certified Copy of Birth Certificate
Denver County Vital Records has birth records for the entire state since 1907.
Information about person whose birth certificate is requested — please type or print. IF ADOPTED , provide adoptive information.
Full name at birth
First Middle Last (s)
Date of birth
Month Day Year
Is this person deceased? Yes □ No □
If yes, date: ____/____/____ State where death occurred: ____________________
Please
rovide co
of death certificate
Place of birth
City County
Full name of father
First Middle Last (s)
Maiden name of mother:
First Middle Maiden (s)
Certificate needed for
Pursuant to Colorado Revised Statutes, 1982, 25-2-118 and as defined by Colorado Board of Health Rules and Regulations,
applicant must have a direct and tangible interest in the record requested. The penalties for obtaining a record under false
pretenses include a fine of not more than $1 ,000.00, or imprisonment in the county jail for not more than one year or both such fine
and imprisonment (CRS 25-2-118)
By signing below, I have read and understood that there are penalties for obtaining a record under false pretenses.
Effective 7/1/2003, all requests must be accompanied by a copy of the requestor's identification before processing. Please return
your request with a copy of your driver's license, state ID or passport. See reverse side for additional accepted documents.
Signature of person making request Relationship to registrant* Driver's License # State of License Expiration Da te
Address City State Zip
Daytime Phone
( )
Ways to order:
Apply in person for same day service. Office hours are from 8: 0 0 a.m. to 4.00 p.m., Monday-Friday.
Order certificates online* at www.VitalChek.com. Certificates mailed within 2 to 5 days business days via regular mail,
UPS 1 to 2 business days.
Fax your application with credit card information**: fax 303-602-3665
Mail in application with check, money order, or credit card information **. Certificate (s) mailed within 3 to 4 weeks via regular mail. *
* Convenience charge to be added. See charges below.
Credit card orders:
Make check or money order
payable to Vital Records
Section. Please do not
send cash.
PLEASE COMPLETE THIS AREA
PRINT name and address of person making request:
Name
Address
City/State/Zip
Cardholder name: ___________________________________________________________
Card Number: ______________________________________ Exp Date ________
Total copies ordered ..................
VISA MasterCard Discover
Card Type:
**Charges
Cost of certificates ($17.75 for 1st copy or
search when no record found); $10 for
each additional copy of same record
ordered at same time) .....................
Convenience charge (credit card orders
$10.00) Walk in excluded .....................
*UPS Service with
CREDIT CARD ORDERS ONLY ($19)
Total Charges .......................................
*Within continental U.S.
$
$_________
$ ________