Colorado Birth Certificates

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Colorado Birth Certificates Powered By Docstoc
					         Colorado Department of Public Health and Environment                                                                                           For Office Use Only
                                            Vital Records Section HSVR-VR-A1                                                                            ID        _____               Cash        _____
                                              4300 Cherry Creek Drive South                                                                             ISS       _____               CK          _____
                                                  Denver, CO 80246-1530                                                                                                               CC          _____
                                                      (303)692-2200                                                                                                                   Other       _____
                                                www.cdphe.state.co.us/certs
                                                                                                                                                        SF#       _____-____________

Application for Certified Copy of Birth Certificate
            Colorado has birth records for the entire state since 1910. Certified copies of certificates are also available from county offices (see reverse side).

Requestor Information
Print name of person making request            First                    Middle                                          Last                          Reason for request:

Mailing Address                                          City                                 State                     Zip                           Daytime Phone
                                                                                                                                                      (      )
Physical Address                                         City                                 State                     Zip                           Alt Phone Number
                                                                                                                                                      (      )

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)

PLEASE RETURN YOUR REQUEST WITH A PHOTOCOPY OF YOUR DRIVER’S LICENSE, STATE ID OR PASSPORT.
(To review the full list of primary and secondary identification, please visit www.cdphe.state.co.us/certs)
 By signing below, I have read and understood that there are penalties for                                         Relationship to Registrant (person                        Today’s date
 obtaining a record under false pretenses.                                                                         named on certificate) *see reverse side


                                                                                                                   Please submit proof of relationship

Registrant Information
Information about person whose birth certificate is being requested — please type or print.
If adopted, provide adoptive information and see special service on other side.
 Full Name at Birth First                                             Middle                               Last

                            Month Day Year                            Is this Person Deceased? ❒Yes                      ❒No            If yes, date: ____/____/_______
Date of Birth
                                                __ __ __ __                                               State Where Death Occurred: _________________________
                                                                                                          Please provide certified copy of death certificate
                            City                                      County                                         State
Place of Birth
                                                                                                                              Colorado ONLY
Full Name of Father         First                                     Middle                                         Last

                            First                                    Middle                                              Maiden Last Name (name prior to first marriage)
Full Name of Mother
  ❒ Check here if you are requesting a certificate of stillbirth
 Ways to Order                                                                                 Charges
 Apply in person for same-day service. Office hours are from 8:30 a.m. to 4:45
     p.m., Monday–Friday.                                                                      Cost of certificates:
 Order certificate online** at www.cdphe.state.co.us/certs Certificate(s)                           $17.75 for 1st copy (or search when no record found)                               $
     mailed next work day upon receipt of all required documentation.
                                                                                                      $10 for each additional copy of same record ordered
 Fax your application with credit card information**: within continental U.S.                         at same time .............................................................       $
      fax 1-800-423-1108; outside continental U.S. fax 1-303-691-9307.
      Certificate(s) mailed at the end of five business days upon receipt of all                      $6 credit card convenience charge (walk-ins excluded)                            $
      required documentation.
 Mail in application with check, money order, or credit card information. Make check                  $50 for each heirloom copy .....................................                 $
      or money order payable to Vital Records. Please do not send cash. Certifcate(s)
      mailed within three weeks upon receipt of all required documentation.                    Please check one:
                                                                                                    ❒ Regular mail ($0.00 - no additional charge for regular
 **$6.00 convenience charge to be added.                                                            mail)
                                                                                                    ❒ Fed Ex – within continental U.S. ($20.00)
                                                                                                    ❒ Express Mail – within continental U.S. ($16.40)                                  $
Credit Card Orders**                                                                           Total ..............................................................................    $
Card Type: ❒ Visa           ❒ Mastercard ❒ Discover               ❒ American Express
Cardholder Name:___________________________________________                                                  Number of standard copies
                                                                                                             Number of heirloom copies
Card Number: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
                                                                                                             Total copies ordered
                      Exp. Date: _____/_________
**$6.00 convenience charge to be added.                                                                                                                                                    08/08 bicert.pdf
*Certified copies of birth certificates may be issued to:
        Please note that proof of relationship is required: (e.g. marriage certificates, birth certificates, court orders)
                    The registrant (person named on the certificate)                             Adult children or grandchildren of the registrant
                    Parents                                                                      Stepchildren
                    Grandparents and Great grandparents                                          Legal guardian
                    Stepparents                                                                  Legal representatives of any of the above must present proof of client relationship
                    Siblings                                                                     Consular Corps
                    Spouse                                                                       Genealogists representing family members with appropriate credentials
Certified copies of certificates are available in the county where birth occurred. The following county offices can issue certified copies for birth occurring anywhere in Colorado for birth
years 1910 to present. Birth cards not available at all locations:
                                                                               Grand County Courthouse
        COUNTY OFFICES:                                                        308 Byers Ave. P.O. Box 120                                          Prowers County Nursing Service
        Alamosa County Registrar                                               Hot Sulphur Springs, CO 80451                                        1001 S. Main St P.O. Box 336
        Courthouse                                                             970-725-3347 ext.110                                                 Lamar CO 81052
        402 Edison Avenue                                                      Fax: 970-725-0100                                                    719-336-2606
        P.O. Box 630                                                                                                                                Fax: 719-336-2985
        Alamosa, CO 81101                                                      Gunnison County Registrar
        719-589-6681                                                           Dept. of Public Health                                               Pueblo County Health Department
        Fax: 719-589-6118                                                      225 North Pine St. Ste. E                                            151 Central Main
        dheiman@alamosacounty.org                                              Gunnison, CO 81230                                                   Pueblo, CO 81003
                                                                               970-641-0209                                                         719-583-4300 (press 4)
        Bent County Nursing Service
        701 Park Avenue                                                        Jefferson County Vital Records                                       Rio Grande County
        Las Animas, CO 81054                                                   Dakota Building                                                      Office of the Clerk and Recorder
        719-456-6042                                                           800 Jefferson County Parkway, Suite 1300                             965 6th Street, PO Box 160
        Fax: 719-456-0518                                                      Golden, CO 80401                                                     Del Norte, CO 81132
        dlucero@bcns.net                                                       303-271-6450                                                         719 -657-3334
                                                                               Fax: 303-271-6451
        Boulder County Public Health                                                                                                                Routt County Northwest Colorado Visiting Nurses
        3450 Broadway                                                          Kit Carson County                                                    Association
        Boulder, CO 80304                                                      251 16th Street                                                      940 Central Park Drive Suite 101
        303-441-1100    Fax: 303-440-3984                                      Burlington, CO 80807                                                 Steamboat Springs, CO 80487
                                                                               719-346-5950                                                         9708791632
        Boulder County Public Health
        529 Coffman, Suite 200                                                 La Plata County                                                      San Juan Basin Health Department
        Longmont, CO 80501                                                     San Juan Basin Health Dept                                           La Plata County
        303-678-6166     Fax: 303-678-6163                                     281 Sawyer Dr., Suite 300                                            281 Sawyer Drive
                                                                               Durango, CO 81303                                                    P.O. Box 140
        Broomfield Department of Health and Human Services                     970-247-5702                                                         Durango, CO 81302
        6 Garden Center                                                        Fax: 970-247-9126                                                    970-247-5702 ext. 201
        Broomfield, CO 80020                                                                                                                        Fax: 970-247-9126
        720-887-2270                                                           Lake County
        Fax: 303-469-2110                                                      115 E 5th Street                                                     San Miguel County Registrar
                                                                               PO Box 24                                                            Office of the Treasurer
        Chaffee County                                                         Leadville, CO 80461                                                  P.O. Box 488
        124 E Street                                                           719-486-0708                                                         Telluride, CO 81435-0488
        Salida, CO 81201                                                                                                                            970-728-4451
        719-539-2311 Fax: 719-539-5271                                         Larimer County Health Department
                                                                               1525 Blue Spruce Drive                                               Summit County Clerk & Recorder
        Crowley County Local Registrar                                         Fort Collins, CO 80524                                               P.O. Box 1538
        603 Main, Ste 2                                                        970-498-6710                                                         Breckenridge, CO 80424
        Ordway, CO. 81063                                                      Fax: 970-498-6715                                                    970-453-3475
        719-267-5222                                                                                                                                Fax: 970-453-3540
        Fax: 719-267-3114                                                      Las Animas County Health Dept.
                                                                               412 Benedicta Ave.                                                   Teller County Clerk & Recorder
        Delta County Registrar                                                 Trinidad, CO 81082-2095                                              101 W. Bennett Ave.
        Office of the Clerk and Recorder                                       719-846-2213                                                         P.O. Box 1010
        501 Palmer St. Ste. 211                                                                                                                     Cripple Creek, CO 80813
        Delta, CO 81416-1796                                                   Logan County                                                         719-689-2951
        970-874-2150                                                           Northeast Colorado Health Department                                 Fax: 719-686-8030
                                                                               700 Columbine
        Denver Vital Records                                                   Sterling, CO 80751-0316                                              Tri County Health Department
        605 Bannock Street                                                     970-522-3741                                                         (Adams, Arapahoe and Douglas County)
        Denver, CO 80204-4507                                                  Fax: 970-522-1412                                                    7000 East Belleview, Suite 301
        303-436-7350                                                                                                                                Englewood, CO 80111-1628
        Fax: 303-436-7321                                                      Mesa County Health Department                                        303-220-9200
                                                                               510 29½ Rd                                                           Fax: 303-221-2906
        Eagle County Health and Human Services                                 PO Box 20000
        P.O. Box 660                                                           Grand Junction, CO 81502-5033                                        Washington County NE Colorado Health
        551 Broadway                                                           970-248-6900                                                             Department
        Eagle, CO 81631                                                        Fax: 970-248-6972                                                    150 Ash St.
        970-328-8840                                                           Karen.Armstrong@mesacounty.us                                        Akron, CO 80720
                                                                                                                                                    970-345-6562
        Elbert County                                                          Moffat County Northwest Colorado Visiting                            Fax: 970-345-6561
        33817 Blue Bird Lane                                                   Nurses Association
        Elizabeth, CO 80107                                                    745 Russell St.                                                      Weld County Health Department
        303-646-4127                                                           Craig, CO 81625                                                      1555 N. 17th Avenue
        Fax: 303-646-0446                                                      9708248233                                                           Greeley, CO 80631
                                                                                                                                                    970-304-6410
        El Paso County Health Department                                       Montezuma Couny Clerk & Recorder                                     Fax: 970-304-6412
        305 South Union Boulevard                                              109 West Main, Room 108
        Colorado Springs, CO 80910-3123                                        Cortez, CO 81321                                                     Weld County Health Department
        719-575-8492                                                           970-565-3728                                                         4209 WCR 24½
        Fax: 719-575-8493                                                      Fax: 970-564-0215                                                    Longmont, CO 80504
                                                                                                                                                    720-652-4240 ext 8842
        Fremont County Local Registrar                                         Montrose County Clerk & Recorder
        Mr. Ray Woodard                                                        320 S. 1st Street, Room 101                                          Yuma County
        611 Main Street                                                        P.O. Box 1289                                                        910 South Main
        P.O. Box 872                                                           Montrose, CO 81402                                                   Yuma, CO 80759
        Canon City, CO 81215-0872                                              970-249-3362                                                         970-848-3878
        719-275-1556                                                                                                                                Fax: 970-848-5101
        Fax: 719-276-5123                                                      Morgan County
        rdwoodard1@yahoo.com                                                   Northeast Colorado Health Department                                 Yuma County- Wray
                                                                               228 W. Railroad                                                      245 West 4th St
        Garfield County                                                        Fort Morgan, CO 80701                                                Wray, CO 80758
        109 8th Street Suite 200                                               970-867-4918                                                         970-332-4431
        Glenwood Springs, CO 81601                                             Fax: 970-867-0878                                                    Fax: 970-332-0691
        970-945-2377 x1950
                                                                               Park County Clerk and Recorder
                                                                               501 Main Street P.O. Box 220
                                                                               Fairplay, CO 80440
                                                                               phone 719.836.4333
                                                                               fax 719.836.4348
                                                                               email: pcclerk@amigo.net
 OPTION AVAILABLE FOR ADOPTIONS:
  Sign below only if you wish "ISSUED PURSUANT TO ADOPTION" to appear on your certified copy of the birth certificate. Only an adoptive parent or adopted
  person is eligible for this special service effective August 8, 2002.

      Number of copies without "issued pursuant to adoption" requested:
      Number of copies with "issued pursuant to adoption" requested:                                                       Signature of :                                            x
                                                                                                                                            adopted person             adoptive parent
                                                                                                                                               (relationship to registrant; check one)

				
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Description: This is an example of Colorado birth certificates. This document is useful for creating Colorado birth certificates.