Application for Certified Copy of Birth Applicant Must Attach: A photo copy of drivers license or other valid identification. No birth certificate will be issued without proper identification. Please Complete All Items Below Name As It Appears On Certificate * date_range access_time Date of Birth * date_range access_time Sullivan County (We can only issue for Sullivan County) * Is this person deceased? * Please select an option Yes No Father's Full Name * date_range access_time Father's Birth State * Please select an option Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Mother's Full Maiden Name * date_range access_time Mother's Birth State * Please select an option Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Your Relationship to Person on Birth Certificate * date_range access_time Purpose for Which this Record is to be Used * date_range access_time Applicant's Name * date_range access_time Applicant's Address * date_range access_time Applicant's Address 2 date_range access_time Applicant's City * date_range access_time Applicant's State * Please select an option Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Applicant's Zip * date_range access_time Phone * 111-111-1111 date_range access_time Number of Copies Requested (Certified Copy $10 Each) * date_range access_time Applicant's Email * date_range access_time Upload Proof of Identification File Uploaded Files: WARNING: False or fraudulent application and altering, mutilating, or counterfeiting Indiana birth certificates is a criminal offense under I.C. 16-37-1-12. * navigate_nextSubmit Your Session Is About To Expire Click continue to extend your session. Your Session Has Expired Close your browser or click OK to begin a new session.
