The US State Department recommends this format of a form for requesting the Birth Certificate records that are needed when applying for a US passport. Please read the instructions below and use this form as often as may be needed.
The Federal government does not maintain copies of birth records of persons born in the United States or its territories. The state or territory where the birth occurred maintains the record. For telephone numbers and addresses of each office, and for current fee information, please see "Where to Write for Vital Records" on our Passport Information page. You may use the form below to request your birth certificate. DO NOT MAIL TO PASSPORT SERVICES. Please note that some States, prior to release, may require the signature of the subject of the birth record or the parent or guardian if the subject is under 18 years of age.
PLEASE DETACH ALONG THIS LINE
PLEASE PRINT OR TYPE
TO: (Office of Vital Statistics Address)
1. THE NAME UNDER WHICH I WAS BORN IS